ourVoices is a new podcast from openDemocracy’s ourEconomy section which explores the crisis of our economic system – and promotes intelligent debate about what should replace it.

In this fourth installment of our special series on the US election, we explore the history of federal healthcare reform, and place the resurgent movement for Medicare for All in the context of decades of struggle for universal coverage.

Listen below – and subscribe on Apple Podcasts, Spotify or Soundcloud.

Transcript:

Freddie Stuart: With over 8.5 million cases, and nearly 225,000 deaths, the coronavirus pandemic has exposed the cruel dysfunctionality of the US healthcare system.

Even before the coronavirus, 87 million US citizens were either underinsured, or had no health insurance whatsoever. 30,000 Americans lost their lives every year because they lacked access to a doctor.

Whilst $11,000 are spent per person on maintaining the system of private insurance, more than half a million families declare bankruptcy each year due to medically related debt.

So how did we get to this point?

Why, in the richest country on the planet, is the healthcare system so woefully defective?

I’m Freddie Stuart, the podcast producer for ourEconomy, and in this fourth installment of ourVoices special series on the US election, myself and North America editor Aaron White will take a deep dive into the history of American healthcare; exposing how this inefficient and ineffective system was first constructed, and placing the resurgent movement for Medicare-for-All in the context of decades of struggle both for and against the implementation of universal healthcare as a human right.

[Clip: W.E.B. Dubois explains the meaning of "The Negro Problem"] [source]

Aaron White: As described by the eminent historian and sociologist W. E. B Dubois, the years following the Civil War were characterised by the radical reconstruction of the union based on democratic principles, and a fight for the economic freedom of former slaves.

On March 3rd, 1865, in the dying months of the conflict, and in the midst of a widespread outbreak of smallpox, President Abraham Lincoln ushered a bill through Congress to establish the Bureau of Refugees, Freedmen and Abandoned Lands – commonly known as the Freedmen’s Bureau.

Among the rudiments of a welfare state established by this legislation was the Bureau’s medical division, constructing 40 hospitals, and employing just 120 physicians this became the first federally run system of healthcare in the newly unified United States.

In the decades that followed this period of Reconstruction, the former slave states of the Confederacy who had lost the Civil War, came to wield enormous political power through a segregationist voting bloc within the Democratic Party.

Democratic President Andrew Johnson repeatedly attempted to disband the Freedmen’s Bureau on the grounds that it violated the rights of former Confederate States, and in 1872, Congress finally responded to pressure from white Southerners and dismantled its institutions.

In the years that followed, this so-called “Dixiecrat” bloc in Congress fought to reaffirm the nation’s racial stratification by adding discriminatory “Black Codes” to federal laws, and upholding the predominance of State rights over universal programs.

As the progress of Reconstruction was rolled back, the US entered a “Guilded Age'' of industrialisation, rampant with inequality and systemic racism.

With only a few hospitals providing minimal therapeutic care, and a system of unregulated physicians paid out-of-pocket, the rapidly expanding American economy entered the 20th century woefully unprepared for an epidemic of disease and a malaise of worker poverty.

With populations growing rapidly, particularly in industrialised urban centres, workers and progressive activists began to push an array of new social reforms at the turn of the 20th century.

Eugene Debs and the Socialist Party pushed universal healthcare from the political fringes, and President Theodore Roosevelt’s Progressive Party even briefly considered the idea in the run-up to the 1912 election, but a lack of political will and a decisive electoral defeat abolished the prospect from the political agenda.

Instead - in response to demands from growing industrial unions - individual companies increasingly began to offer various forms of employee insurance to guard against potential sickness and loss of pay.

As such, the United States entered WWI in April 1918 with no federally organised system of healthcare for its 100 million citizens.

[Clip: The Great Depression] [source]

Freddie Stuart: In the years after the Depression, labour militancy and union leadership focused their demands acutely on addressing rampant unemployment.

In March of 1933, Franklin Delano Roosevelt was propelled into office on a mandate to take on big business, put an end to reckless speculation, and implement his New Deal agenda of sweeping social reforms.

[Clip: Franklin D. Roosevelt inauguration address] [source]

But while successfully implementing a comprehensive investment-led and union-backed spending plan to revitalise America’s floundering economy, Roosevelt’s new social democracy ultimately shied away from plans for universal healthcare.

Throughout the 1930s, influential lobbying groups had begun to form on behalf of the burgeoning private healthcare industry.

The American Medical Association (AMA), which had incorporated in 1897, became one of the first institutions to organise on behalf of health professionals - within 2 years, its membership captured nearly half the nation’s physicians.

Excluding black doctors and black medical students from its ranks, the AMA grew in both size and influence, and by the time of Roosevelt’s election, had become a significant force in DC politics.

[Clip: Men of Medicine (American Medical Association, 1938)] [source]

Defending the stake of its members in the existing system of private care, the AMA attacked the idea of nationalised public insurance as “UnAmerican” “socialized medicine” - throwing nearly a million dollars a year into publicly defaming the concept.

This smear campaign was so effective, that by the time of FDR’s famous Social Security Act in 1935, he was forced to drop his original proposal for publicly-funded universal health care from his New Deal program.

Instead, new legislation aided the growing market for employment-based insurance.

As medicine developed, hospital and physician costs began to rise, and new third-party insurers stepped in to an lucrative market.

In 1929, a group of Dallas school teachers had signed a contract with Baylor University Hospital to create a unique program - receiving up to 21 days of inpatient care a year for regular monthly payments of 50 cents.

By 1937, 26 of these prepaid service plans, with more than 600,000 members, had formed across the country.

The ‘Blue Cross’ network, which provided coverage for hospital services, and the ‘Blue Shield’ group covering physician expenses, became the foremost examples of a growing system of third-party insurance.

Without significant pressure from labour unions or a strong social movement, political fear of organised medicine dominated DC policymaking - setting a precedent that reforms could be dictated by the whims of the growing healthcare lobby.

[Clip: Sir William Beveridge Talks To Pathe Gazette (1942)] [source]

Aaron White: The height of World War II, British economist and Liberal politician Sir William Beveridge drew upon the earlier work of health activists to set forth his vision for what post-war reconstruction might look like.

The Beveridge Report proposed widespread reforms to the British system of social welfare, focusing in particular on an expansion of National Insurance and the creation of a National Health Service (NHS) financed by the government through tax payments.

While the public welfare state was taking shape in the UK however, in the US the system of private welfare was rapidly expanding.

With American entry into the war, a large section of the American workforce was diverted to military service, and businesses faced severe labour shortages.

To prevent inflation, FDR signed an economic stabilization order which listed tight caps on both prices and wages.

In response, the private sector adapted, offering an array of employment benefits in lieu of wages to lure in prospective workers. These included paid vacations, on site childcare, and increasingly, comprehensive healthcare coverage.

[Clip: FDR's Economic Bill of Rights] [source]

In 1944, Roosevelt outlined the “the right to adequate medical care, and the right to achieve and enjoy good health” in his Economic Bill of Rights, and in 1945 a proposal was tabled before Congress to introduce a national medical insurance program financed through social security payroll taxes.

Enjoying the strong support of soon-to-be President Harold Truman, the so-called Wagner-Murray-Dingell bill faced an unprecedented onslaught from the AMA.

As the Cold War dawned, red-baiting became the norm and attacks increasingly focused on Communist espionage at the highest levels of government and a Soviet-inspired plot to socialise American medicine.

[Clip: Joseph McCarthy Congressional Hearings] [source]

Taking on the presidency after the death of FDR, Truman’s election victory in 1948 gave him the mandate to push forward what he termed, his Fair Deal agenda.

Once again, this program included national healthcare insurance financed through social security payroll taxes, and once again the AMA spent over a million dollars on anti-reform propaganda, filling television and radio slots.

In the face of these vitriolic attacks, and in defence of his own anti-Communism agenda, Truman dropped his plan for universal coverage.

He would later call it the greatest “disappointment” of his presidency.

Between 1940 and 1950, the share of US citizens with employment-based health coverage jumped from 9.1% to over 50%.

While the United Kingdom emerged from the Second World War with a fully-formed and publicly funded National Health Service - installed by the newly elected Labour Government under Clement Attlee and Aneurin Bevan - in the US the window of opportunity had been lost, the growing system of third-party insurance was now the undisputed primary provider of healthcare across the world’s largest economy.

Freddie Stuart: Throughout the 1950s, the health insurance industry began to formalise its political influence.

“Those of us with deep convictions,” AMA president James Foristel observed in 1956, “must do more than vote.”

That same year, insurers established an official lobbying arm, the Health Insurance Association of America, which increasingly championed a lucrative line of group-based private coverage and the light hand of state regulation.

It wasn’t until the election of JFK’s Democratic administration in 1961 that the mere idea of universal health care once again broke into the political discourse.

[Clip: JFK argues for universal healthcare] (source)

Known as “Medicare”, Kennedy proposed a national health insurance program which would specifically cover people over the age of 65.

Like previous initiatives to expand state subsidized health care coverage, the AMA – who viewed government intervention as an existential threat to the for-profit healthcare industry – launched another crusading PR campaign against the proposed reforms.

Physician, epidemiologist and public health expert, Dr. Abdul El Sayed tells us more:

Dr Abdul El-Sayed: During World War 2 the then relatively small insurance industry had taken hold and the insurance industry, plus doctors, worried that collectivising healthcare, as you all did in the UK, would end up destroying their bottom line and so they rallied against it. The term "socialised medicine" was used as a bugaboo. There's some famous clips of a young Ronald Reagan, railing against socialised medicine in the 60s before he was ever elected president.

[Clip: Reagan ad against “socialized medicine” & Medicare recorded for AMA in 1961] (source)

And this scared a lot of folks away. In fact, a lot of modern campaign tactics, using this mass advertising, was developed by the AMA in the advent of pushing against efforts to collectivise healthcare. And so we have a long history of efforts to try and collectivise that have been met with large corporations scaring people into what might happen and using some of our countries worst history against our best potential future.

Freddie Stuart: After JFK’s assassination in 1963, major healthcare reform was taken on as a central pillar by the new president, Lyndon B Johnson.

In 1965, Johnson’s administration succeeded where his predecessor had failed (withstanding the counter offensive of the insurance lobby) and passed amendments to Roosevelt’s Social Security Act, which created Medicare.

[Clip: Johnson signing Medicare into law] (source)

This legislation had an immediate impact. Medicare provided public insurance for those over the age of 65.

Where prior to the act, only 50% of the elderly population had hospital insurance, by 1970, 96% of people eligible for the scheme had coverage.

Also included as an amendment to the legislation was Medicaid – a new program which aimed to cover the medical costs for the poor and disabled.

Unlike Medicare, which is federally funded and administered, Medicaid was created as a “joint federal-state program” in which states receive partial federal support in covering the costs for eligible recipients. (The Federal Government contributes 50-83% of payment services provided under each Medicaid program).

Also, in contrast to Medicare which entitled every person over the age of 65 to coverage, Medicaid was a means-tested program, whose eligibility requirements and benefits packages were to be determined by particular states.

While its neighbor to the north, Canada, instituted a comprehensive national insurance program in 1966, the US’ newly cherished Medicare system still left a vast percentage without access to affordable healthcare.

As liberal politicians and organizations celebrated the reforms - radical activists, such as the Black Panther Party, called out the remaining coverage gaps, which exposed the racial and class divisions at the heart of American society.

[Clip: Fred Hampton on healthcare] (source)

The Black Panthers maintained that full social equality would never be possible under a system that treated healthcare as a commodity, and excluded those it could not exploit for-profit.

In cities such as Chicago, the Black Panthers set up health clinics in the late 1960s (as part of their “serve the people” programs) to deal with the egregious lack of healthcare access in poor Black communities.

Aaron White: In 1971, as an inflation crisis led the Nixon administration to impose wage and price controls around the country, a new political window opened to complete the push toward a universal healthcare system.

Under the leadership of the Republican president, and a Democratic controlled legislature - the major parties jostled to convince the electorate of their preferred vision for the future of American healthcare.

[Clip: Nixon vs Kennedy on health care] (source)

Leading the healthcare committee in the Senate, Democrat Ted Kennedy of Massachusetts championed a new vision of single-payer healthcare.

[Clip: Ted Kennedy plan] (source) (start 2 secs in)

Under this scheme, Kennedy sought to offer a single government-funded national health insurance program as a universal alternative to the expensive and insufficient private system.

Facing both partisan and internal party disputes, Kennedy ultimately endorsed more moderate legislation, which would have retained the private health insurance industry whilst providing a public option for those without coverage.

But a deal with Nixon was never reached, due in part to opposition from the AMA and the president’s resignation after the Watergate scandal.

[Clip: Reagan inauguration speech] (source)

Ronald Reagan’s election to the presidency in 1980 marked a sharp turn of mainstream politics toward the neoliberal economics of Milton Friedman and the Chicago School.

His administration proceeded to go to war on “big government” – cutting entitlement spending and deregulating the executive state.

Reagan proposed cuts to Medicaid spending and reforms to Medicare; and as a bipartisan neoliberal consensus gripped both major parties, the vision for universal healthcare was abolished from the political agenda.

1980 was the last year that “national health insurance” was included in the official Democratic Party platform.

Outside the Washington bubble however, a growing movement across the country spawned in the 1980s against this establishment consensus.

[Clip: 1988 Jackson Campaign Speech at the American Federation of State, County, and Municipal Employees] (source)

In 1988, Jesse Jackson returned to the campaign trail in his second bid for the presidency.

Traversing the country to build his famous “Rainbow Coalition”, Jackson’s campaign pushed for a range of universal policies. His proposed National Health Program highlighted the absurd economic inequality in the United States, criticizing the greed of the private insurance industry, and setting out a strong moral argument for the universal provision of publicly funded healthcare as a human right.

Jackson came close to winning the Democratic nomination, gathering 40% of the delegates at the ‘88 convention, on a radical platform which effectively repudiated the more centrist wing of the Democratic Party, represented by Michael Dukakis, and rising national party stars Bill Clinton and Al Gore.

The surprising momentum that Jackson’s campaign was able to garner marked a revival in the movement for universal healthcare, and firmly demonstrated that comprehensive social welfare policies still had a broad mass of popular support - even in an era when both political parties were increasingly preaching fiscal austerity and an end to “big government”.

Following the neglect of the Reagan and Bush presidencies, millions of Americans remained without any health insurance whatsoever. And during the period from 1978 to 1990, the number of uninsured grew by 14 million people each year – to a total of 40 million Americans.

[Clip: 1992 DNC Presidential Campaign Commercials] (source)

Freddie Stuart: During the 1992 presidential campaign, the Democratic Arkansas Governor Bill Clinton, harnessed the popularity of Jackson’s 1988 platform, and rhetorically advocated in favour of universal health care.

However, once elected, the actual substance of his healthcare policy drastically differed from the demands of activists outside the halls of power.

Upon entering the Oval Office, President Clinton established a Health Care Task Force appointing his wife, then First Lady Hillary Clinton, to lead the project.

Instead of proposing a single-payer program, the administration followed in the incrementalist approach of its predecessors, advocating for a managed marketplace, which would expand the existing employer-based health insurance system. (Private special interests reportedly held powerful sway over the policy recommendations.)

The plan included a compulsory mandate for employers to provide insurance to cover all employees (smaller businesses would receive subsidies to provide insurance) – as well as subsidies to the unemployed or those in precarious work.

Even though Clinton’s proposals were modest in comparison to many of his Democratic predecessors, it was still met with an unprecedented negative PR campaign from the Health Insurance Association of America, who poured $14 million into ads to sway public opinion.

[Clip: "Harry and Louise" Health Care Ads] (source)

The Heritage Foundation and other conservative think tanks also mounted a PR blitz of ads, newspaper editorials, and congressional memos - condemning Clinton’s healthcare plan as a government overreach.

Without a strong popular movement to counter the onslaught of negative media pushed from corporate healthcare interests, the reform was ultimately defeated in only a year – as the administration failed to build sufficient support to even get a floor vote “in either chamber of Congress”.

As Clinton’s legislative priority was overwhelmingly defeated, structural healthcare reform remained off Washington's agenda for another two decades.

And by the dawn of the new millennium nearly one in seven Americans had no healthcare coverage whatsoever.

[Clip: Barack Obama on John McCain's Health Care Plan] (source)

Aaron White: During the 2008 presidential campaign, healthcare reform was at the top of the country’s domestic concerns – 116 million people – more than a third of the population -– still remained either uninsured or underinsured.

Barack Obama campaigned on a promise to regulate the excesses of the private healthcare market, and create an alternative - affordable - public insurance plan – known as the “public option”.

Following his historic rise to the presidency, Democrats looked poised to finally pass the widest healthcare reform since 1965 – wielding dominance of the House, and a filibuster-proof majority in the Senate.

Once the negotiating began however, Obama quickly retreated from his campaign pledge – dropping the public option due to pressure from corporate friendly advisers and conservative members of the Democratic caucus.

[Clip: President Obama Signs Health Reform Into Law] (source)

Obama’s Affordable Care Act - known colloquially as Obamacare - consists of 2 major coverage expansion programs.

Firstly, it created an online marketplace on which consumers could easily compare subsidized private insurance programs.

Under this new system of “managed competition”, Americans were mandated to purchase a private health insurance plan (or pay a tax penalty) - the choice of which was simplified into 4 ranked tiers: Bronze, Silver, Gold, and Platinum, based on quality and expense.

[Clip: President Obama Explains Healthcare.gov] (source)

The other major addition in the original ACA was Medicaid expansion.

In the initial passage of the bill, Medicaid was expanded in all states for those with incomes up to 133% of the federal poverty line (with the federal government paying nearly the entire cost of the expansion and then lowering it to 90% over time).

Just two years later, the Supreme Court struck down this provision, ruling that individual states should have the freedom to opt-out of Medicaid expansion.

[Clip: Supreme Court strikes down Medicaid expansion] (source)

Ultimately, Obamacare did succeed in dramatically expanding affordable healthcare in the United States. It allowed children to remain on their parents insurance until the age of 26; it compelled insurers to offer plans to those with pre-existing medical conditions; and it ensured that birth control would be free of charge.

But even as the number of uninsured people dropped from around 44 million, to less than 27 million by the end of Obama’s tenure, many today regard the ACA as a rare missed opportunity to actually legislate for a simple system of universal healthcare.

Dr. Abdul El-Sayed: It’s been a missed opportunity, because still 10% of our country is without healthcare and the median American is finding it harder to afford healthcare at all. One of the things that a lot of folks don’t understand unless you’re in the US context is how insurance companies often work.

So you pay a “premium” which is bi-weekly or monthly fee to have insurance coverage. And then to get access to the insurance you already paid for, you have to pay at the point of care, if you are going to an outpatient service, that’s called a “co-pay”. And then, if something bad were to happen and you were to get hospitalized, the insurance doesn’t actually begin until you pay what’s called a “deductible” which can be $5,000 - $10,000 out of pocket to even get to the services that you already paid for in your insurance.

And those costs have gone sky-high because the insurance companies want, in effect, to make money off of you, and they found that the best way to do that is to pass the healthcare costs back on the consumer on the backend, when they don’t know that it’s going to hit them. The hard part about this is that you know, the operative word in insurance is “sure”, and the idea is that it’s there for you when you need it, and for too many Americans it’s not. It’s a failure of this idea that markets can solve healthcare problems. They can’t. We need to collectivize, that’s Medicare-for-All in America.

[Clip: Medicare-for-All, Bernie Sanders] (source)

Freddie Stuart: In April 2015, Vermont Senator Bernard Sanders officially entered into a long-shot bid for the presidency - going up against the party establishment favorite, former Secretary of State Hillary Clinton.

Sanders’ campaign called out America’s egregious levels of wealth inequality, and a broken political system tied to the whims of corporate lobbyists.

Articulating a structural and moral critique of the US private healthcare industry – Sanders’ campaign took inspiration from the outsider popularity of Jesse Jackson, back in the 1980s.

Lawrence Hamm was the New Jersey co-chair of both Jesse Jackson’s ‘88 campaign and Sanders in 2016.

Lawrence Hamm: This liberal wing of the Democratic party pushes forward when it has the strength to do so, and it had the strength to do so in 1988. In fact, Jesse Jackson ran twice. He ran in 1984. He ran in 1988. His platform was very much in the vein of, I won't say identical to, but in that vein of Bernie Sanders’ platform of 2016. And so again, we had that pushing forward of the liberal wing in the 1980s, and then it fell back, it pushed forward again in 2016 with Bernie Sanders. Only this time, I would say, not just the liberal elements of the Democratic party, but progressive elements because Sanders platform was qualitatively different than previous platforms of insurgent candidates within the Democratic party. And I guess the market feature, the place where you would start would be Medicare for All. Even in the liberal platforms that have been put before by other candidates, they did not call for the complete overhaul of the healthcare system, but Sanders did in 2016.

Bernie Sanders served a very important purpose with his campaign of 2016, and his partial campaign of 2020. He showed demonstrably that there are large numbers of people, very large numbers of people in the United States that will support a progressive platform. They will support Medicare-for-All, doubling the minimum wage, abolishing student debt, free college, ending the wars in Iraq and Afghanistan, and the Green New Deal. Probably 50% plus of the country is ready for that, and it's really being held back by the leadership of the party, which is still in the hands of the corporate and establishment Democrats.

Freddie Stuart: Sanders’ Medicare-for-All plan proposed a single-payer national health insurance program in the vein of Canada, which would be free at the point of service, and eliminate the existing system of private health insurance.

Under these plans, all premiums, deductible and copays would be abolished, Medicare’s remit would be expanded, and an annual cap of $200 would be implemented per person on prescription drug costs.

Every US resident, including undocumented immigrants, would be eligible for coverage.

Dr Abdul El-Sayed: Medicare for All is a single payer healthcare program where the government becomes all of our insurer. And that has a number of benefits. Number 1, it instantly covers everyone. Number 2, it eliminates a lot of the overhead costs that come with private insurance which include huge CEO pay, marketing costs. And then the overhead that exists both with the insurance industry and the healthcare industry – the doctors and hospitals with whom you actually get care – where they all have to know how to interface with each other. Every insurer has a different set of forms etc, which means that the overhaul overhead costs of healthcare even on the provider side are extremely high. So the costs go down. Medicare’s overhead right now is about 2-3% percent, while private insurance is about 15%, so you’re reducing the costs right there.

But there’s a more powerful driver in reductions of costs which is that if you have one buyer of healthcare which is what the government becomes under Medicare for All, it becomes what’s called a “monopsony”. Now everyone knows what a monopoly is, which is where you have one seller of a good. A monopsony is when you have one buyer of a good, and that buyer has similar price setting capacity just like a monopoly does. And if the government is buying healthcare on all our behalf, it can negotiate down the cost of healthcare, the cost of pharmaceuticals and bring down the cost for everybody.

And then that allows us to add benefits that even traditional Medicare, which the program for people over 65 doesn’t cover. Things like mental health and dental services, long term care, auditory and vision services, which ought to be covered.

This is different than the UK’s system. The UK is a single provider system, where the government is both your insurer and buyer of healthcare – you go to an NHS hospital and see an NHS doctor. In Medicare for All, you’d be seeing a private doctor at a private hospital, but you’d be paid for, and covered by the government which is your insurer. It’s a lot more similar to what they have in Canada.

Freddie Stuart: Although Sanders failed in his bid for the Democratic nomination, he outperformed expectations – gathering 43% of the overall primary vote. In just several years, a popular movement for universal healthcare was revitalized in the United States.

Outside of Washington, polling indicated that 70% of registered voters supported Medicare for All. In DC, politicians began signing on to Sanders’ plan.

[Clip: "Pivotal Moment in American History": Sen. Sanders Unveils Medicare-for-All Bill with 15 Co-Sponsors] (source)

With powerful national labour unions, such as the National Nurses United, endorsing Sanders’ proposal, prospective Democratic candidates entered the 2020 cycle with comprehensive healthcare reform as a central issue.

Following the Republican 2017 tax cut, which repealed the “individual mandate” and narrowly failed to repeal the system of Obamacare in its entirety, many Democrats’ tapped into the popular desire to protect and expand healthcare coverage.

[Clip:Progress, Pete Buttigieg for President] (source)

Rhetorically supporting a Medicare-for-All program, many of the candidates actually proposed watered-down versions of Sanders’ original vision - often retaining a substantial role for the influential private insurance industry.

Sanders’ himself was attacked from the right, both by his competitors and the liberal media, who criticised his proposal as radical and too expensive – oppressive for its lack of consumer choice, and anti-union on the basis that workers would be displaced from their existing insurance.

Aaron White: Despite the terms popularity on the Democratic debate stage, former Vice President and now nominee Joe Biden, refuses to endorse a Medicare-for-All plan, instead outlining separate proposals to “protect and build on Obamacare”.

[Clip: Biden: We Have to Protect & Build on Obamacare] (source)

Like Obama’s original proposal for the Affordable Care Act, Biden’s plan promises to create a new option for public health insurance.

The public option would allow people to purchase what he terms a “Medicare like” plan, on the healthcare exchange - at reduced prices.

The public option would also be available – premium free – to all those eligible for the Medicaid expansion (people making below 138% of the federal poverty level), even those in states that chose to opt-out of expansion under the ACA.

Biden has also pledged to increase the value of tax credits, and use subsidies to lower premiums on private plans - ensuring no one pays more than 8.5% of their income on insurance.

But whilst these proposals do mark a substantial advance in the quest toward universal coverage, they do not match the universal scope of a Medicare-for-All plan, through which healthcare is guaranteed to all, and free at the point of use.

By tip-toeing around the profits of the private sector, many healthcare activists, argue that Biden’s healthcare plan shies away from the fundamental question at the heart of the American healthcare system. Should healthcare be a commodity, to be bought and sold as a conduit of exchange, or a right to all regardless of income?

As Dr Abdul El-Sayed explains, this sense of universality is integral to building a functional public health system fit for the 21st century:

Dr Abdul El-Sayed: Universality is critical. If you want a single-tiered system that truly does provide equitable access to healthcare for everybody, you can’t create two tiers. What “Medicare for All who want it” is, is a fancy political way of framing what’s called a public option, where the government has an insurance plan that you can buy into. The problem with this is that it does not hold the private insurers at bay – buy in effect eliminating them – like Medicare for All would. Because it doesn’t hold the private insurers at bay, it allows them to continue to create a lot of the mis-incentives in the system that are locking people out of the system and keeping healthcare costs too high.

Now how do we get this? Well look. We know that the industry has a huge amount of money. And that money is going to be used to advertise against Medicare for All as it has in the past. Just like the AMA and the health insurance providers did to destroy efforts to get universal health insurance in the post WWII era like we already talked about. The reason that so many Medicare-for-All supporters support Bernie Sanders is because he recognizes that it’s not just about the policy, it’s about the politics that are going to get this done. And that means bringing organizing power to bear against the advertising power of the industry.

Freddie Stuart: Throughout this ourVoices documentary, we’ve seen how the movement for universal healthcare has consistently risen and fallen through the 20th century. Multiple attempts have been made, both by politicians and movements, to guarantee healthcare to all Americans as a human right.

But whether it was Roosevelt’s New Deal in the ‘30s, or Ted Kennedy’s campaign in the early ‘70s, the movement for guaranteed care has repeatedly been met with a wall of opposition, from both the healthcare industry and its many benefactors.

With the election of Ronald Reagan, and the neoliberal turn in the 1980s, the notion of universal healthcare was shut out of mainstream political debate in Washington for almost 30 years. And when Obama finally brought it to the forefront, off the back of a devastating recession in 2008, his conservative concessions ultimately crippled the chances for universal expansion.

With 8.5 million cases, and over 225,000 deaths, the United States has long-since become the epicentre of the coronavirus pandemic worldwide.

A nation with 87 million uninsured or underinsured at the start of the crisis has seen a further 12 million kicked off their coverage, as the worst economic decline on record takes hold.

We are now only a week away from an era-defining general election, which, amongst other things, will determine the future of healthcare for the American people.

As Donald Trump and the Republican Party continue to undermine the existing system of health security, Joe Biden and the Democratic Party are intent on protecting and expanding affordable care.

If elected, Joe Biden’s plan with it’s “public option” is predicted to expand coverage to 97% of Americans, in what would be the most comprehensive healthcare reform since the passage of Medicare and Medicaid in 1965.

Outside of Washington however, with Covid-19 raging across the country, and Congress stalling over a much-needed stimulus package, Medicare-for-All has rapidly become one of the most popular policies across the United States.

Progressive politicians, supported by a burgeoning popular movement on the streets, continue to call for healthcare, free at the point service, as a human right.

If Biden’s wins on November 3rd, a political window will once again open up to redefine the future of healthcare in the United States.