How the United States Can Fix Healthcare, According to the Presidential Candidates

5 min readJun 30, 2020

Part X: Yes, Now is the Perfect Time to Talk Healthcare in America

Note: This post is one part of my series, Yes, Now is the Perfect Time to Talk Healthcare in America, which provides an in-depth look at the current healthcare system so that it can be reformed. Click the link or scroll to the bottom to check out the other posts in the series.

The Challenger

Healthcare will be a pivotal issue this November. Both presidential candidates have differing views related to The Affordable Care Act and the general path toward amending the healthcare system.

From the Democratic viewpoint, the presidential nominee, former Vice President Joe Biden, presents a plan to increase government-run and funded healthcare. According to his website, his healthcare plan focuses on a public option where “if your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare.”

In context, Biden’s plan builds on the ACA; a law he helped deliver as vice president. It seeks to reduce some of the ACA’s manifested inefficiencies and loopholes. Additionally, Biden strives to shrink the number of uninsured Americans. He intends to make Medicare accessible to 138% of the federal poverty level. Therefore, it will cover some people over the poverty line. He has publicly stated that he will allow Americans at the age of 60 (currently 65) to buy into Medicare as well. While expanding government-provided health insurance, he will leave the vast majority of coverage to private insurers. His plan chooses to strengthen the ACA, and reign in the private sector, but not entirely box it out.

The Incumbent

From the Republican viewpoint, the incumbent, President Donald Trump offers a different view. On his website, the President promotes his administration’s accomplishment of “allowing small business to pool risk across states and a six-year extension of the Children’s Health Insurance Plan to fund government healthcare for 9 million.” While an ardent opponent of the ACA, he has publicly pledged to maintain Medicare and protections related to preexisting conditions.

President Trump ran on the idea of “Repeal and Replace” — meaning with something better. In 2017, the American Health Care Act (AHCA), was the Republican alternative to the Affordable Care Act. This bill, which died in the Senate, focused on reneging provisions in the ACA, promoting cross-state competition, and reducing the government’s role in health insurance. When AHCA failed to pass, the Trump administration turned to the courts to challenge the ACA’s legal standing. To date, the administration has eliminated the individual mandate and disincentived insurers to remain on ACA-created marketplaces.

Thus, President Trump has sought to remedy the challenges with the ACA by first trying to replace it with something it deemed better and then chip away at some of the ACA’s provisions. It now challenges its constitutionality and, by association, its existence. At this juncture, it’s unclear if the President plans to reinvigorate the AHCA or back a new plan. He maintains that he will tackle the problematic components of the ACA, promote a more state-oriented structure, increase the supply of generics to lower drug prices, and seek more private involvement. If the administration’s legal challenges succeed, it is uncertain what will happen to the 20 million Americans who currently rely on the ACA for healthcare.

The Defeated

Lastly, a “Medicare for All” plan gained traction during much of the Democratic primary season. Senator Bernie Sanders championed this concept. Senator Elizabeth Warren would later support it as well. While their proposals were slightly different, they’re structurally similar. They asserted that a “Medicare for All” plan would be the most expedient way to get everyone insured.

Their plans promoted phasing out private health insurance over the course of a few years to a decade. Essentially, it would automatically enroll every American in the Medicare program. It would end the Affordable Care Act just as it would private health insurance. All Americans would be covered without paying premiums and likely co-payments and coinsurance too.

In context, both Senators acknowledged that middle class taxes would increase. Even though they proposed paying for their plans predominately through corporate taxes and hikes on the wealthiest in society, the sheer price tag would be enormous — even by the most conservative estimates.

After all, they would scale Medicare from about 61 million to 328 million Americans. In comparison, the ACA extended coverage to about 20 million Americans over about six years and it didn’t exactly go smoothly. As mentioned, its rollout was messy, it didn’t uphold all of its promises, and caused Democrats to get historically thrashed in the 2010 midterm elections.

A decade later, it teeters as being net favorable. However, these Senators’ plans guarantee universal coverage, drastically cut systemic inequities, create more payment synergy, eliminate private health insurance, and reign in industry. Unlike the ACA, Medicare already exists, so it wouldn’t be a matter of start up as much as ramp up. It would most dramatically reshape the current healthcare system in America.

This approach, while bold, currently has the least appeal to the American population. It both ends the ACA and stymies the private sector’s role. Preferences can surely shift with time; however, in this moment, it goes against what the majority of Americans say they want. If circumstances change, it could become more viable, but it seems widely at odds with voters’ attitudes right now.

Thanks for reading! If you enjoyed this post please clap, share, and feel free to add me on LinkedIn to share any feedback. For links to all of the other blog posts included in this series, see below.

1. Yes, Now is the Perfect Time to Talk Healthcare in America

2. The History of Pre-1970s Healthcare

3. The History of Modern Healthcare

4. What is Medicare?

5. The Debate Around the Affordable Care Act

6. Three Areas Where the American Healthcare System Actually Works

7. Three Areas Where the American Healthcare System Fails

8. The Driving Forces Behind America’s Healthcare Cost Problem

9. Voter Attitudes Surrounding Healthcare

10. How the United States Can Fix Healthcare, According to the Presidential Candidates

11. International Healthcare Systems: Western Democracies

12. International Healthcare Systems: Eastern Democracies