As California gears up for its gubernatorial primaries and debates, the familiar issues dominate the conversation: housing affordability, crime, taxes, and economic pressures. Health care surfaces, but rarely as a central priority with concrete, actionable solutions. Candidates offer broad strokes on affordability or protecting programs from federal changes, yet the crushing realities of escalating costs, physician shortages, regulatory burdens, and a system skewed against preventive, relationship-centered care receive little more than theoretical acknowledgments.

This omission reflects a deeper failure in how we conceptualize health care. We treat it as episodic transactions in exam rooms rather than a foundational driver of individual well-being, community vitality, and broader societal success. California’s challenges demand more than incremental tweaks. They require visionary leadership that prioritizes innovation, pragmatism, and a holistic view of health.

The realities facing California’s health care system

California’s health care system is among the most expensive in the nation, yet outcomes lag and access frays. Average family premiums exceed $28,000 annually, outpacing national figures. Medical debt burdens millions, with 3 million Californians struggling to pay bills in recent data and over $10.5 billion owed statewide. Many forgo care or basic necessities due to costs.

Compounding this is a worsening physician shortage. Projections indicate California already faces a primary care physician shortage. Millions already live in primary care shortage areas. Regional disparities hit hardest in the Central Valley, Inland Empire, and rural areas.

Why the exodus? High taxes, burdensome regulations, and a legal environment that feels stacked against physicians are accelerating the problem. Burdensome regulations and an aggressive medical board create constant scrutiny. A legal system that feels tilted against physicians, despite Medical Injury Compensation Reform Act (MICRA) reforms, drives defensive medicine and high defense costs, even in winning cases. Many doctors close private practices, reduce hours, retire early, or relocate to states with friendlier environments. The result: fewer traditional doctor-patient relationships, longer waits, and strained safety nets.

Add the rise of artificial intelligence (AI). AI promises diagnostic support, administrative relief, and personalized insights. Yet without intentional integration that preserves the human core of medicine, it risks further depersonalizing care. We stand at a crossroads: Allow the system to erode further or innovate boldly.

Moving beyond the narrow exam room mentality

Health care cannot be confined to the 15-minute visit or whether a procedure meets narrow evidence-based criteria for authorization. That moment remains sacred as the trust, empathy, and clinical judgment between physician and patient form its foundation. But we must expand our vision.

View every patient as a whole person embedded in a community. Their physical and emotional well-being influences family stability, workplace productivity, school performance, and neighborhood safety. A healthier patient contributes to economic output, reduces downstream societal costs (lost wages, disability, crime linked to untreated mental health or chronic disease), and creates positive ripple effects.

Prevention and prophylaxis must take center stage. Reactive care, for example, treating advanced disease after it manifests, is far costlier and less effective. Investing in upstream interventions (lifestyle counseling, chronic disease management, behavioral health integration, community wellness programs) yields dividends. Research shows preventive approaches reduce hospitalizations, emergency visits, and long-term expenditures while boosting productivity.

For example, strengthening primary care can prevent thousands of avoidable hospital stays annually, saving billions. Community-level successes, lower obesity rates, better mental health, increased physical activity all translate into stronger local economies and reduced strain on public resources. This scales nationally and globally: Healthier populations drive innovation, trade, and shared prosperity in an interconnected world.

Aligning incentives for real change

Current incentives misalign. Fee-for-service rewards volume over value. Prior authorizations and bureaucratic hurdles burn out physicians. Low reimbursement for cognitive and preventive services discourages the relational work that matters most.

A better model incentivizes outcomes that extend beyond the exam room: reduced community disease burden, improved patient-reported well-being, and measurable economic and social returns. Physicians who help patients thrive see the broader impact in their own communities like stronger schools, businesses, and families. This creates intrinsic motivation and professional satisfaction.

Practical steps for California leadership include:

• Tax and regulatory relief: Stem the physician exodus and support private practices.
• Malpractice and legal reforms: Balance accountability with fairness, reducing defensive medicine.
• Investment in primary care and prevention: Expand residency slots, offer loan forgiveness targeted at underserved areas, and adopt payment models rewarding longitudinal care.
• Smart AI integration: Reduce administrative burden (documentation, prior authorization) while augmenting, not replacing, clinical judgment and human connection.
• Community health metrics: Track not just procedure volumes but population health, equity, and economic multipliers in state accountability systems.
• Cross-sector partnerships: Link health care with education, housing, nutrition, and employment programs.

These are not utopian ideals. They are necessities grounded in evidence that prevention and holistic approaches deliver both better health and economic returns.

A call for innovative leadership

California cannot afford to treat health care as a secondary debate topic or a series of isolated fixes. The next governor must elevate it as a cornerstone agenda item the one that addresses costs head-on, halts the talent drain, embraces technology thoughtfully, and reorients the system toward prevention and community flourishing.

When we step out of the exam room and consider the patient as a community member, we begin thinking globally. Success in the consultation room fuels stronger families, resilient neighborhoods, thriving economies, and a more competitive California on the world stage.

Physicians stand ready to partner in this transformation. We entered medicine to heal, not just to process claims or defend lawsuits. Give us the environment to practice at the top of our license, with incentives aligned to what truly matters, and we will deliver the care our patients, and our communities deserve.

The debates highlighted many problems. Now is the time for solutions that are specific, evidence-informed, and boldly visionary. California’s health, economy, and future depend on it.

Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.

Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.

Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.