Health care in America is a mess. We are spending twice as much as other countries, with worse outcomes. But the problem with health care is not a lack of resources, but rather a misallocation of resources. Unfortunately, there are powerful forces—such as pharmaceutical and insurance companies, and specialized doctors—who are benefiting from this situation. They intend to use their money and political power to maintain the status quo. And we can't count on rational decision-making from Washington, D.C. This is the bad news.

The good news is: We have the power, if we choose to use it, to dramatically improve health care in our region.

We have the power to provide health-care coverage to more than 90 percent of all legal residents. There are roughly 200,000 uninsured people in Sacramento County. Covered California will offer coverage to a large number of these people, and many of them will be eligible for federal subsidies. In addition, the Affordable Care Act will make it easier to qualify for Medi-Cal. We need to spread the word, to make sure all Sacramentans who are eligible for health-care insurance and Medi-Cal receive it.

We also have the power to make our health-care system much more efficient and effective. We need to redirect people from expensive emergency rooms and into community clinics.

People do not enjoy sitting around in pain. People end up in emergency rooms because they do not know where else to go. Encouraging visits to a community clinic will help to reduce health-care costs and improve patient outcomes.

We have the power to help people in our region have more control over the health care they receive at end of life. Only a small percentage of Sacramentans have advance health-care directives or living wills. If advance directives became a standard practice, we could improve people’s final days while helping them save money that is currently being spent on unnecessary and costly procedures.

We have the power to change how we treat those who suffer from mental illness. By respectfully recognizing their problems, we can remove barriers and stigma which are stopping them from getting much-needed treatment. In addition, we can elect district attorneys who will direct nonviolent, mentally ill offenders into treatment instead of jail.

We have the power to provide solid, reliable health-care information to the people in our region, many of whom are making ill-advised decisions because they have received information whose major purpose was to increase pharmaceutical-company revenues.

And we are lucky that locally we have the Sierra Health Foundation and the Healthy Sacramento Coalition, who are working with 82 local health-care organizations to reduce tobacco use, obesity, disability and death due to chronic disease; reduce health disparities; build a safe and healthy physical environment; and improve the social and emotional well-being of Sacramento County residents.

Health-care change can happen locally. We have the power, and we can create meaningful change.