The Democrats are back in the driving seat. Some are demanding a complete overhaul of the health care system, specifically from progressive Senator Sanders. Sanders has just been named to the strategic position of Senate Budget Committee Chairman. Does this mean that the left and center of the Democratic Party will finally agree on a more comprehensive health insurance system?
Senator Bernie Sanders is already promoting his campaign for a universal, public health insurance model with a vengeance:
“I am a very strong advocate of Medicare for All. I introduced legislation in the Senate. I think, at the end of the day, the American people understand that our current health care system is so dysfunctional, so cruel, so wasteful, so expensive that we need to do what every other major country on Earth does, and get health care to all people. What we will be doing is working within the context of what Biden wants.”
Sanders’ statement comes as no surprise. As a senator from the progressive state of Vermont, he has been fighting for years to implement a public health care system in the United States similar to models in Europe. This has long been a core aim of progressives in Wisconsin, from the days of Roosevelt’s New Deal to the debate around Bill Clinton’s proposed health care reform in 1993. That was when progressive Democrats started to advocate for single-payer health care – that all essential health care be covered by a single public system, rather than private insurers.
Seeking a fairer health care system while the pandemic rages
For many in the United States, the debate remains the same – it’s still a case of choosing between a “grand illusion” of universal care and a “feasible solution”. However, the Covid-19 pandemic, which has caused nearly 450,000 deaths so far, has pushed supporters of public health care to speak out more forcefully, right when the Biden administration is taking over.
So what can we expect from the new president? As part of the moderate wing of the Democratic Party, Joe Biden was not supportive of Medicare for All during the primaries. He stated that he was in favor of improving the Affordable Care Act (ACA), Barack Obama’s health care reform, which gave coverage to 20 million Americans who previously had none. Under the act, popularly known as Obamacare, Americans are encouraged to get private health insurance, with public assistance for those who could not afford to do so. Two longstanding public programs with narrow criteria complete the system: Medicare (for those over 65 years old) and Medicaid (for minors and single women).
Biden was in favor of increasing public funding so that all citizens could afford insurance, essentially an Affordable Care Act 2.0. The high public cost of Medicare for All as well as the number of Americans who are relatively satisfied with the current employer-based system meant that the Delaware senator considered larger reform out of the question.
However, with Kamala Harris as his running mate and now vice-president, and an eye on getting progressive Democrats on board, Biden has shifted to the left. One such move was proposing a more substantial reform of Obamacare, introducing a “public option”. Harris had earlier come out in favor of an “open” version of Medicare for All, with the option to take out supplementary private health insurance. The two compromised on a solution with both private and public insurance. However, this kind of reform requires budget legislation that cannot be passed by a simple majority (which the Democrats have in the Senate). They would need a supermajority of 60 votes to get it through, and avoid Republican obstruction (a.k.a., the filibuster).
What’s more, with the absolute priority currently given to the fight against the Covid-19 pandemic, it’s unclear whether Biden will take an extra step toward the far-reaching reform sought by progressive Democrats. Looking at the make-up of Biden’s new administration, one cannot precisely assess the importance that this issue could have on the upcoming political agenda. Out of the 19 executive positions in the Department of Health awaiting appointments, and approval by the Senate, only one has been confirmed – Dr. Francis Collins, the new director of the National Institute of Health. Nominations of Xavier Becerra as the secretary, as well as the deputy and assistant secretary candidates, are awaiting confirmation.
By comparison, the 2008–09 Obama administration was set up as a sort of task force, with a number of veterans from the Clinton administration. These advisers, many of whom held positions in the White House and Department of Health, backed the consensus-based health-insurance reform bill. There is nothing of the sort in the current administration.
A bare majority for Democrats in Congress
President Biden’s main priority is to fight the Covid-19 pandemic, hence his promise for “100 days, 100 million vaccinations”. This is also his reasoning behind the recruiting of his chief of staff, Ron Klain, who as part of the Obama administration was responsible for managing the US response to the Ebola epidemic.
Responding to Covid-19 also allows for the triumphant return of experts to the White House, who were both badly treated and side-lined by the Trump administration. Biden’s choice of the ten members of his task force shows a change in tack. And the nomination of Jeff Zients, an economist and a former Obama advisor, to coordinate the federal vaccination program reaffirms this choice. Zients was the one who fixed the rollout of the ACA’s federal health insurance marketplace website.
Assessing the Biden administration’s opportunities for substantial US health care reform requires a careful reading of the recent election results. Despite Trump’s baseless claims, Biden comfortably won, but there wasn’t a “blue wave” in Congress. The Democrats actually lost seats in the House of Representatives and have only the barest majority in the Senate, with Harris as the tiebreaker vote. Any major Medicare for All–type reform bill will inevitably be subject to criticism from the Republicans who warn against so-called “socialized medicine” while dismissing the benefits of universal care. The Biden administration has also committed $1.9 billion to fight the impacts of Covid-19, with more planned.
All this means that it is likely that Biden will choose to improve the ACA, introducing measures by passing budget legislation or budget balancing, which would only require a relative majority in the Senate (50 votes).
As vice-president, Harris will likely will leave her health care reform agenda for a later date. Committing to such a reform without having 60 Democratic votes in the Senate would be a major political risk for the 2022 midterm elections. And there are certainly other issues to tackle, such as securing minority rights or providing a stable situation for the 11 million undocumented immigrants or the 700,000 “dreamers” (children of migrants born in the United States). These political battles are just as deeply felt as Medicare for All and certainly much less risky for Harris, who no doubt hopes to embody the future of the Democratic Party in the post-Biden era.
The Fact check US section received support from Craig Newmark Philanthropies, an American foundation fighting against disinformation.
Translated from the French by Rosie Marsland for Fast ForWord.