The Democratic Party — whether by the free will of the voters or the machinations of the party’s leaders does not matter for present purposes — has chosen Joe Biden to be the nominee for the general election. This is a choice made in a time of duress after three years of Donald Trump’s administration and the current pandemic, and many of his supporters say that a desire to return to normality has motivated their decision, but they should consider the reality that for many Americans, the status quo ante was itself bad.
Biden has declared his opposition to Medicare for All, campaigning on a commitment to Obamacare out of what I must presume is an unwillingness to admit the failures of that program. The Affordable Care Act, a program that is a stuttering version of the Swiss system, might have worked in 1993 — the Swiss adopted their current healthcare law in 1996 — but only by including a comprehensive individual mandate and a guarantee of insurance for low-income people through programs like our Medicaid. Their system has the second highest expenditures per capita, almost double what the British National Health Service costs, but they are still paying less than we do with our lack of guarantees and requirements for buying insurance, but their disease burden is the second lowest in the developed world. Whether or not this is the result of their relatively high spending on healthcare is beyond the scope of this article. What I can say here is that their system appears to work well enough for the Swiss.
By contrast, through a combination of Obama’s hands off approach to the process of getting legislation through Congress, of the fecklessness of Democrats in the same, and of Republican refusal to allow anything that helps ordinary people to become law, we are living in a system that reduced the uninsured rate by about twenty million, but that still leaves more than twenty-seven million out. And that was prior to the layoffs that we are currently experiencing with the COVID-19 pandemic. Biden would like to play around the edges of Obamacare, adding in the Medicare public option that might have saved the program if enacted in 2010 and guaranteeing contraceptives, but not restoring any measure of mandate.
In other words, his plan is an unimaginative attempt to do very little without any consideration of how it would overcome Republican opposition. The latter point might be said of the Medicare for All plan of Bernie Sanders, but consider the key difference. The Sanders plan is something that a candidate would be able to campaign on. It has the appeal of saying to voters that with their aid in getting a worthy president and Congress elected, everyone will have comprehensive healthcare, care that leaves nothing out. The Biden plan takes paragraphs of explanation with lots of footnotes on all the ways that it is not a guarantee for all. Laws often have to be complicated, but when the people are the ones who will have to sort through the details, rather than regulators and providers, the program is not going to have a lot of popular support.
And what of the costs? Biden claims that the Sanders plan would run to thirty-five trillion dollars over ten years. This sounds like a lot, but it would be only the same as what we are paying now. And his claim ignores the cost savings that spreading out the risk pool across the entire population and allowing a single payer to negotiate fees bring in countries like Canada and Australia, in addition to reductions in expenditures thanks to the improving health that guaranteed care produces.
Up to this point, I have included the United States among the developed nations, but the reality is that for millions of us, we are rightly categorized by the optimistic term, developing. Or, put more honestly, left behind. Many on the right wing will connect this term with their fantasies of a rapture, but for people who live in this world, it informs us that much of this country is not receiving the blessings of our wealthy society. The extremes of this current crisis cannot be allowed to make us forget that we have been living in a healthcare crisis for decades. And healthcare is but one of the many parts of our society that are fundamentally broken.
I titled this article with a play on a line from The Who’s “Won’t Get Fooled Again.” I will conclude by telling John Lennon that yes, I do want a revolution. I would prefer that it be of the velvet kind, but if we cannot bring ourselves to make things work through the legislative process, having elected politicians who work for the people, the history of this country suggests one of two directions we will go: uprising or acquiescence. Either of those would be a disaster. Franklin Roosevelt rescued us from these ends with the New Deal and the war against fascism. Joe Biden is no Franklin Roosevelt, and it is a good question as to whether or not he can even remember who that is. If he cannot convincingly adopt a progressive agenda, he will have a weak argument in calling for the votes of progressives and will certainly lose any claim to being the contrast of leadership to Donald Trump.