Healthcare in the United States is one of the many topics that Republicans and Democrats diverge on greatly, and it highlights the fundamental differences in economic and social approaches of the two parties. This split has been increasingly significant since the 2010 Affordable Care Act (ACA, or Obamacare) was put in place, and a major part of Donald Trump’s 2016 presidential platform was its repeal. This became even more important in 2017 after he failed to repeal it, and caused Republicans to lose control of the House in 2018.
With the ACA now due to be debated in the Supreme Court in early November, it is undeniable that healthcare remains a crucial theme for the election. This is especially key in the midst of the pandemic (which is spiking to levels higher than ever in the US, just as huge rallies are held over key battleground states) with Trump’s record of dealing with the pandemic being heavily criticised. Despite the current situation, Trump continues to stand by the commitment to take it away. This could be devastating, as during the pandemic, an estimated 27 million people have lost their insurance coverage as they were fired from jobs which provided them. On the other hand, Democrats have passed many healthcare bills to increase provision among the vulnerable, and Biden plans to continue this legacy if he is elected.
Trump’s sanity has been questioned before, but during the pandemic he has gone to new heights with suggestions of injecting disinfectant as a way of treating the virus, and has been slow to respond to increases in infection rates with restrictions. This has led to reductions in approval ratings, and has again shown his blatant disregard for truth and a lack of awareness for his actions.
In the final presidential debate, Biden talked about building on the ACA to make more substantial, affordable healthcare available to more people. He proposes offering a public health insurance option, which would increase competition with private insurers, and therefore should reduce costs. The main argument against expanding public healthcare interventions is financing, and ensuring the budget is balanced. However, there will be healthcare cost savings if people get problems checked out early instead of waiting until they’re debilitating because they don’t have insurance - making preventative care the norm would be hugely beneficial on all fronts. Better health would also lead to less days off from work, never mind the improved quality of life, which would be dramatic for those with long term conditions who have been paying thousands for medicines.
Trump is not forthcoming on what his alternative to the Affordable Care Act would be if he overturned it. In the final presidential debate on the 22nd, while arguing that ‘[Biden] did not do anything’ during his time in government, he failed to explain what protection there would be for the 20 million Americans who currently get their insurance through ACA, if it is repealed. The popularity of ACA is because of how it protects people with pre-existing health conditions, and while Trump has stated that he has a great alternative, he has failed to make one public.
Pundits are uncertain as to Trumps’ viable alternative, and this could be the cause of Biden’s current substantial lead. Conversely, several Democrats have advocated getting rid of private healthcare altogether and going to a pure public system, which would be costly. A huge proportion of the US economy rests with healthcare insurers, and thus any transition to reduce their prevalence would necessarily be a gradual and carefully designed process.
The election will be of paramount importance for the future of US healthcare. If Biden wins, we can expect to see expanding the existing protections for citizens greatly. There are members of his camp who have a vision to provide free healthcare to all citizens in a UK-style system. In comparison, Trump will press forwards with his previous attempts (which did not result in the change he wanted) to revoke much of the social protections that are in place now. With his approval ratings dropping over the course of the pandemic, could this be the turning point Democrats need to get back in office?
The debate is interesting but goes back to a fundamental question of the ideal extent of government intervention. Over the past few decades, politics in the US has shifted increasingly leftwards, which may surprise readers. And generally, the government has just increased in size. It is a tragedy that so many people in one of the richest countries in the world cannot afford to keep themselves protected from accidents and illness. For a country with a huge fiscal capacity, and large defence spending, it is more of a question of prioritisation of government funds, rather than capability. I think the pandemic has exposed serious issues with the healthcare system in the USA and where it’s failing, and a plan like Biden’s will help to make the system more robust to shocks like these in the future.
In a few hours time, we will know the trajectory of (at least) the next 4 years of American healthcare, which will no doubt have a prolonged legacy.