Terrell A. Williams of Middletown is an attorney.
Delaware’s Democratic governors have failed to modernize our healthcare systems, while catering to powerful healthcare monopolies.
Since 1992, Delaware has expanded access to health insurance and public health programs, including Medicaid, children’s coverage and Affordable Care Act protections. But expanding coverage is not the same as ensuring that Delawareans can obtain timely, affordable and comprehensive medical care. Under 34 years of Democratic governors, Delaware continues to face shortages of primary care physicians, specialists, nurses, dentists and behavioral health professionals, creating longer wait times and uneven access across the state.
Mental health and dental care illustrate the problem particularly well. Delaware has struggled to meet the demand for behavioral health services, while dental care shortages remain among the most significant gaps in the state’s healthcare system. Vision care and prescription medications present additional affordability and access challenges, particularly for low-income and medically vulnerable residents. A Delawarean can technically have health insurance and still struggle to find a provider, obtain a specialist appointment, afford medication or receive preventive dental and vision care. Is this what three decades of Democratic leadership are supposed to look like?
Cost is another persistent problem. Delaware’s healthcare spending continues to rise, placing pressure on families, employers, insurers and taxpayers. In 2023, Delaware’s per-person healthcare spending increased 9.1%, substantially exceeding the state’s 3.1% annual spending growth benchmark. Prescription drugs alone accounted for approximately $2 billion in medical expenditures. These numbers raise an important question: If Delaware continues to spend more on healthcare, why does access to timely and comprehensive care remain so difficult for so many residents?
After more than three decades of healthcare policy and government investment, Delaware should measure success by more than the number of people who have insurance. The real measure should be whether Delawareans can see a doctor when they need one, obtain specialized and mental health treatment without unreasonable delays, receive dental and vision care, afford their prescriptions and obtain quality care without being overwhelmed by cost. Delaware has expanded its healthcare system since 1992, but the state still has work to do to ensure that coverage actually translates into accessible, affordable and effective healthcare for ordinary Delaware families.
Delaware is also facing the growing challenge of an aging population, which will place increasing pressure on the state’s healthcare system. As more Delawareans reach retirement age, demand will grow for primary care, specialists, prescription medications, long-term care, home health services and mental health support. The state must prepare now for this demographic shift by expanding its healthcare workforce, increasing access to geriatric and specialized care, and ensuring that older Delawareans can age with dignity without making healthcare financially unattainable.
Gov. Matt Meyer’s unwillingness to allow Delaware State University to lead the charge in developing the next generation of medical practitioners, despite DSU’s prominent position in central and southern Delaware, is difficult to understand. Even more baffling is Meyer’s decision to partner with Thomas Jefferson University to lead the new medical school, rather than allowing DSU to recruit medical leaders from prominent institutions such as Howard University and Morehouse School of Medicine — or even experienced administrators from Jefferson — to build a medical school under the DSU banner. DSU already has a substantial foundation in health-related education — including nursing, public health, social work, psychology, occupational therapy and other programs — that could form an integrated academic model in which students and professionals across disciplines collaborate.
For a state that has historically relied on partnerships with out-of-state medical institutions through the Delaware Institute of Medical Education and Research, Delaware’s decision to establish its first four-year medical school through Jefferson raises an important question about whether the state is fully leveraging the capabilities of its own public institutions. DSU could have been positioned as a central part of a Delaware-based medical education pipeline, particularly given its existing health professions programs and its location in central Delaware. At a time when Delaware is confronting an aging population, physician shortages and growing demand for healthcare services, the state should be willing to consider whether its public university can play a larger role in training the professionals Delaware will need for the next generation.
Delaware’s healthcare system also suffers from a lack of meaningful competition. A small number of dominant hospital systems control much of the state’s hospital market, giving patients and insurers fewer alternatives, while healthcare costs continue to rise. Delaware’s per-capita healthcare spending increased 8.7% in 2024, substantially exceeding the state’s 3% spending benchmark, with hospital services accounting for a significant share of total expenditures.
The problem is not simply the size of these health systems; it is whether consolidation has produced greater affordability, access and better outcomes for Delawareans. When patients have limited choices for hospitals and specialized care, meaningful competition becomes more difficult, while the negotiating power of large health systems increases. Delaware’s creation of the Diamond State Hospital Cost Review Board reflects growing concern over hospital costs and market power, while the state’s ongoing efforts to increase competition acknowledge that consolidation remains a significant policy challenge.
The question is simple: How much longer can Delaware afford more of the same stale Democratic leaders running the state?
The calling card of inept Democratic leaders has always been the claim that it will take years to fix an American economy broken by failed Republican policies.
But what if the problem in Delaware is not failed Republican policies or a broken federal system increasingly polarized by pundits and tribal politics?
What if the problem is more local and less definable than many of us realize or can articulate?
What if the problem is Democrats? Or the Democrats’ “Delaware Way” of governance?
You may be asking, “What is the ‘Delaware Way?’”
The “Delaware Way” is best described as a relationship-driven political culture shaped by a small cohort of public and private leaders — one that is often insular and resistant to change, with important decisions being shaped by a relatively small network of political, business and institutional insiders.
I often laugh at the notion that it takes years to fix a problem in government. I become frustrated even, as I hear the same tired arguments repeatedly regurgitated by an assembly line of ambitious Democratic leaders waiting their turns to pass through the governor’s mansion turnstile.
When I first moved to Delaware, I incorrectly believed that the primary barrier between moderate and progressive Democrats was ideology. But the division within Delaware’s Democratic Party along ideological lines is a relatively recent development. So, what is the real problem? I think the real problem is that Delaware’s Democratic Party is filled with moderate Republicans masquerading as Democrats because of social ostracism, the extremes of the opposing party and an increasing number of independents who identify primarily with single-issue concerns.
After 34 years of Democratic leaders, Delaware’s infrastructure, public resources and social outcomes in some areas can resemble those of states such as Alabama, Arkansas, Mississippi and West Virginia. Issues that should bring unanimous support are tanked because of personal beliefs and animus. Delaware is the missing cog preventing the Mid-Atlantic from revolutionizing its regional public transportation system and allowing Amtrak to focus on developing the high-speed national service that could help normalize train travel in the United States.
Why is Delaware trailing neighboring states such as Pennsylvania, New Jersey and Maryland on many of the issues traditionally associated with the Democratic platform, while simultaneously struggling with social safety nets and other outcomes that can resemble those of poorer Southern states, many of which are or were governed by Republican leaders?
Ambition. In three decades, Delaware has failed to produce the landmark technological marvels that should signify the state’s ability to compete nationally and globally. Yet initiatives designed to position Delaware for that competition have too often been disregarded or abandoned under the misnomers of cost, time and misinformation.
With history as our North Star, President Bill Clinton showed us that fixing broken policies does not necessarily take years, and neither does overcoming failed leadership require a lifetime in office. In the first months of his presidency, Clinton signed the Omnibus Budget Reconciliation Act of 1993, which reversed much of the Reagan-era tax-cutting approach by raising the top income tax rate on high earners in an effort to reduce the federal deficit inherited from the Reagan and Bush administrations. By the end of Clinton’s presidency, the federal government had achieved a budget surplus. Delaware is not the whole country; it is Delaware. And Delaware should stop using the size of its problems as an excuse for the length of time it takes to solve them.
Maybe Delaware really is experiencing Groundhog Day. Phil Connors spends years trapped in the same day, watching the same events unfold, while searching for a way out. Sometimes, Delaware feels much the same — full of potential yet trapped in a cycle of familiar problems, familiar promises and too few results.
As a Democrat, I have learned an uncomfortable truth: Not all Democrats are created equally, especially in Delaware. Like Sen. Jay Bulworth, my political filter is off. Delaware does not need more political niceties or promises. Delaware needs leaders willing to challenge the status quo and be judged by what they accomplish.
Authenticity should be measured by results, not rhetoric, potential or hope.
After 34 years of the failed Democratic gubernatorial paradox, change is needed.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
