The health care system, a divisive issue

Health care is a key issue in Democratic primaries. Every Democrat running for president wants a system that provides affordable and quality universal health care. But here comes the trouble : how to stand out among the other candidates, without creating too big a fracture within the Democratic Party ?

Health care. Two words at the heart of the Democratic primaries. Actually, these two words are often at the heart of every American election. The Democrats know this issue is very important for the American people. According to the Huffington Post, sixty-two percent say health care is one of their top three issues for this year’s primaries.

« Care is a human right, not a privilege »

In 2012 with Obama, and during the last midterms elections in 2018, health care propelled democrats. When Trump wanted to get rid of Obamacare a couple of years ago, the opposition won back the House of Representatives. So saying health care is a major theme would be an understatement.

The recent TV debates showed how health care was at the center of every discussion. “Care is a human right, not a privilege. I believe that. I will fight for that”, Sanders said during the first debate. This reform can determine whether they win or lose the election. The main question is whether to expand on what’s in place or convert it to an entirely new system.

Polling shows a majority of Americans want universal health care, but are more skeptical when it comes to a “single-payer” system. They are also really frustrated with health care costs.

This worry is firstly explained by the exorbitant price of drug prescriptions and health care overall. On average, for Americans who already have health insurance, they spend more than $1,100 out of their pockets for health care every year, the second-highest sum in the world behind Switzerland.

An expensive and unequal system

Despite this, half of Americans already have insurance coverage through the work and about 15 million buy individual insurance on the Obamacare marketplace. The federal state program, Medicaid, which helps elderly people with limited income with their medical costs, concerns 45 million people. Nevertheless, about 27 million Americans are still uninsured…

According to another poll from the University of Chicago and the West Health Institute, 40 percent of Americans prefer skipping a recommended medical test or treatment and 44 percent say they don’t go to a doctor because of cost. The American health care system is expensive and unequal…Thus, a part of the population is left at the wayside. The main democratic candidates promise voters that, thanks to their new reforms, Americans will pay less for their health, which is a pretty attractive promise.

Voters want to know how candidates are going to fix them, and they are paying close attention to the different proposals. Let’s review our troops!

The candidates can be divided into three groups: Bernie Sanders, Elizabeth Warren, and all the others.

Bernie Sanders

He represents the single-payer Medicare-for-all. In this system, the government steps in (rather than insurance companies) as the intermediary between patients and providers in health-care transactions.

Every American would get health insurance from the government after a brief transition period. Private insurance plans would be prohibited.

According to his team, there would be no cost sharing, “except for an annual $200 deductible for pharmaceuticals”.

Elizabeth Warren

She is going for the public option associated with Medicare-for-all :

For the first two years, most private insurance options would remain, as would Medicare and Medicaid, and a new government plan would be made available for anyone to join. Roughly 135 million people would qualify for free coverage under the public option, according to the Warren’s campaign estimates.

Warren is already looking to the long term, and saying she would pass Medicare-for-all in her third year in the White House, therefore banning all private coverage. But for her first year as president, she would focus on a “public option”, covering 90 percent of medical costs on average. She would also “increase the tax subsidies available to purchase private insurance through Obamacare”, according to her team.

Warren pledges to end cost sharing for everybody under the single-payer government insurance program which she says she will eventually pass, though she doesn’t specify a timeline for achieving that.

Joe Biden, Pete Buttigieg, Michael Bloomberg, Andrew Yang, Amy Klobuchar, and Tom Steyer

All of them have private insurance options. Medicare and Medicaid would remain in place. A new government plan that is open to everyone would be created.

Under both Biden and Buttigieg’s proposals, US workers could choose to join the plan. In Buttigieg’s variation, companies would also have the option of deciding whether or not to send their workers to the public plan and pay most of the costs.

All the candidates want health care to cover “essential health benefits”, with some additions for Sanders and Warren, such as dental and vision or medical transportation.

How do they pay for it ?

This is arguably the most difficult question for Democrats and their health care plan.

We easily saw in the debates that the budget is what the candidates attack each other about the most. It’s also the area where they have the biggest divergences. But this is where they must be careful: they all have to defend their own proposals without trashing the others too much. whomever is chosen to battle Trump in the next election, all the others should will rally behind him (or her).

Warren in particular has been targeted during the debates, and political spectators attribute her relative decline in the polls to the health care debacle. “I don’t think it is realistic”, Biden answered of Sanders’s program during the Democratic debate in June. Sanders waves the question away, saying he doesn’t think he needs to come up with a specific financing plan right now.

The more moderate candidates, by contrast, use the tax problem to attack the more progressive proposals as infeasible and politically toxic. Buttigieg in particular has gone after Warren, Biden has said the same kind of thing.

An expensive reform

In the near term, the single-payer option is definitely more expensive than a public option. The single-payer system would cost between $21 trillion (Warren) to $36 trillion (Sanders) over the first 10 years, depending on who you ask. The public option plans are estimated to cost $1.5 trillion, or possibly even less. But over the long term, all of these plans will require more money.

A second political issue remains, health care reform is difficult without a democratic majority in the Senate. Democrats have to win it in 2021 to implement their measures throughout the country. The president needs the backing of at least 51 senators including some conservatives… It is best to say that the task will not be easy.

Rahma Adjadj, Clara Echarri