The US healthcare system offers American citizens both the best and the worst in the world. No one doubts that there are excellent medical enclaves of the highest level in the US; however, at the same time, medicines and insurances are not as expensive for the user in any other healthcare system in the developed world.
During the Obama administration, the Affordable Care Act (known as ACA or “Obamacare”) was an enormous and qualitative step forward in the right to health. Obama campaigned for the Presidency with that project among his most important commitments. The ideal ACA model was a universal system based on a unique fiscal contribution, just like in Canada, all of Europe, Japan, Australia, etc. In short, the system successfully adopted by all countries in the capitalism spectrum that have agreed that the right to health is a human right. However, Obama, aware of the political difficulties that such structure would encounter in the US, due to parliamentary unfeasibility, decided to advance with an intermediate formula. His proposal made private insurance mandatory while creating a market system promoted by the government that facilitated competition among different options, which meet the minimum coverage requirements defined in the law, dismantling regional monopolies or oligopolistic agreements to the detriment of the insured. That alternative included federal subsidies for the most vulnerable sectors and, among many other conquests, introduced a key one: the obligation for insurers to cover people with pre-existing conditions.
The Obamacare model, hindered from day one by state governors affiliated with the Republican Party, has been working better in those states whose governments do not participate in the boycott of its operation. In fact, in some states with Democratic governors, such as Virginia, legislative reforms were introduced, supported by federal contributions included in the law that add to the resources of the regional government, to expand the reach of Medicaid, an essential system for the most vulnerable sectors.
The biggest irony of the systematic Republican opposition to Obamacare is that it was inspired by a law promoted by the Republican Mitt Romney when he was governor of Massachusetts, with bipartisan support and even the green light from conservative economists, including the Heritage Foundation. Nonetheless, bipartisan solutions ended there. It only took Obama elevating Romney’s idea federally to declare war. The response of the obscene lobbying of insurance companies and the pharmaceutical industry was foreseeable. Thanks to Obama’s ACA, over 20 million people obtained medical coverage at a reasonable cost, bringing the total national basic coverage in the country to 90% of the population for the first time at the end of 2016. This significant legislative advancement was passed during the first two years of the Obama administration, exclusively with the support of Democratic members of Congress. Fortunately, Obama put all his effort into fulfilling that legislative priority, because he lost the House majority in the first midterm elections and the Senate majority later on. Otherwise, millions of families for whom doctors were simply unaffordable, would have plunged into chaos or forced to declare bankruptcy.
Since Donald Trump was sworn into office, he has tried to dismantle Obamacare with the support of Mitch McConnell in the Senate unsuccessfully and, by the way, without offering an alternative. What he has done is poke holes into the legislation from his administration through regulations that have made it harder to implement the law. As a result of Trump’s boycott, insurance premiums have increased in some states, and, unfortunately, the index of people without medical insurance has increased by 3%.
According to the polls, healthcare is a priority in the scale of American concerns, as well as a collective demand for a better system. In the Democratic primary, it is a fundamental debate issue, and all the candidates believe that the right to health is a human right. Moreover, a group of proponents, led by Elizabeth Warren and Bernie Sanders, propose a new reform to make a definitive jump towards a universal healthcare system. Joe Biden offers the alternative, attractive because of its pragmatic and viable progressiveness in the Obama style. He promises to defend the Obamacare system and build better legislation from it to perfect it. Biden even proposes to introduce a public option so that the citizens get to decide between the private insurance system and the public offering.
Even when the public universal healthcare system is desirable as a proposal, Biden’s option is, without a doubt, a more viable pathway (and, according to polls, less controversial among the electorate), especially if we consider Obamacare’s the arduous and rocky path. Moreover, the fiscal impact of Biden’s proposition is also gradual. This is important not because we accept the premise of conservative economists, who allege that the public universal healthcare system would be unaffordable, but because that fiscal gradualness adds to the argument of political viability. In fact, the US healthcare system, financed between fiscal contributions and those of citizens who pay premiums to insurance companies, already cost more than that of the countries with public universal healthcare systems with a single fiscal contribution. The US invests 17.9% of its economy GDP into health, while Germany, Switzerland, Spain, Canada, or the United Kingdom do not spend more than 12% of their GDP. These five countries have full universal coverage with higher quality in superior illnesses and health situations that affect most of the citizens. All public health indicators from these countries are superior to that of the US.
In a recent trip to Taiwan, as part of a delegation of the Democratic Party, we were able to witness, during meetings with healthcare authorities of said government, that the healthcare system—based on a public option with subsidiary private complements—costs around 6% of its GDP, while also exhibiting better public health indicators than the US. When asked about the origin of their legislation, the officials stated with great simplicity that it was based on the advice of American experts from Harvard and Johns Hopkins universities. That is to say, there is an American solution, discarded by the political diatribe, which works wonderfully in Taiwan! The answers are working abroad, but we are not applying them at home.
Indeed, the political debate, degraded by the scandals of the Trump administration, has lost sight of the deliberation on fundamental issues. What is clear is that while the Trump White House incubates the greatest threat to health, the Democratic Party has chosen a better health system for the American people as a priority.