Courtney: What happened to health care?

A main topic of the 2020 Democratic primaries–health care– seems to have vanished from the public discourse in Washington. Why might this be?


by Zach Courtney


Let’s flash back to better times: It is early 2020. The COVID-19 pandemic has yet to wreak havoc on the United States. The Gophers just finished an 11-2 season after topping Auburn in the Outback Bowl. Life is good.

In the political world, the discourse was different than it is in 2022, to say the least. On the Republican side, President Trump is regularly sending … unique … tweets out, and the trial for his first impeachment has just concluded.

On the Democratic side, the primaries are in full force. Long shot candidate Andrew Yang dropped out, but he seems to have won just by bringing universal basic income to the forefront. Bernie Sanders, the progressive candidate that lost the nomination just four years ago to Hillary Clinton, appears well-positioned to win the nomination, after winning the popular vote in the first three states.

On a more fundamental note, though, it seems that there is a regular, healthy discourse in the Democratic primary around how we can and should improve our healthcare system. Though the Affordable Care Act — Barack Obama and the Democrats’ reimagination of Romneycare out of Massachusetts that features an individual mandate and bars insurance companies from refusing to cover treatment for preexisting conditions — has had some success, it also is far from enough. The Democrats seem to understand this.

The disagreement seems to be on how far to go; the progressive wing of the Democratic Party, led by Bernie Sanders, is advocating for a single-payer, universal healthcare system, dubbed Medicare for All. The moderates, led by Pete Buttiegeg and later by Joe Biden, are advocating for a more modest, but still good proposal of a government-run health insurance option, commonly known as a public option.


Now, let’s flash forward to 2022. As the pandemic still lingers, Americans are still waiting for robust improvements to healthcare. A 2021 Pew Research survey found that Americans consider the affordability of health care to be the biggest issue facing our country today.

Even the modest provisions in Build Back Better — capping insulin costs at $35 per month, expanding Medicaid to GOP-led states that have yet to expand, allowing Medicare to negotiate drug prices — seem to have little momentum in Washington, let alone things like a public option (something Biden campaigned on) or a more robust single-payer system.

My question, which also serves as my headline, remains: what happened to health care? I’ll get to what I think the best answer is, but first I need to explain why there are certain explanations I just don’t buy.

Reason #1

A seemingly reasonable answer is that the war in Ukraine puts just too much on our politicians’ plate; if there was no war in Ukraine, certainly the Democrats would be moving on healthcare, but they simply can’t do so yet!

In simple terms, this is ludicrous. If the Democrats in Washington cared enough to pass robust improvements to our healthcare system, they could. They have majorities (even if they are small) in both houses of Congress — for the rest of the year, anyway — and hold the White House as well.

As Sen. Bernie Sanders (I-VT) said, “Our job is to punish Russia for this uncalled for and illegal and terrible invasion … But at the same time, here’s the point that I want to make. We cannot lose focus on the crises facing working families in this country with or without a war. You’ve got 80 million people in this country who are uninsured or underinsured, and people cannot afford the high cost of prescription drugs without a war.”

I agree, Senator. Congress can and should walk and chew gum at the same time. Congress has the ability to take on more than one issue at a time.

Reason #2

Another seemingly reasonable answer is that robust healthcare reform would just cost too much. We can’t afford it!

The reality is that healthcare reform would save money for just about everyone besides health insurance executives. If the Senate passed the same version of Build Back Better that passed the House, the Congressional Budget Office estimates we would save $79 billion over ten years. Medicare for All would save us a lot of money while also covering everyone. Even a Koch-funded study found that Medicare for All would save $200 billion per year, while other left-leaning studies find the savings to be even bigger. Not only would these healthcare reforms be inexpensive, but they also would be more cost-efficient than our current system.

So, why aren’t Congressional Democrats taking aggressive action on health care? I don’t buy that their hands are full with the war in Ukraine; Congress could act on healthcare as well if it wanted to. It can’t be that it would cost too much or that Americans don’t want robust healthcare reform; these statements are simply not true. So, what is it?

The real reason

I don’t know for sure, but I think I have an idea: corruption.

If stalled healthcare proposals are the peanut butter, corruption is the jelly; when you see one, expect the other. This case is no exception. As this article by David Moore at Sludge outlines, Senate Majority Leader Chuck Schumer (D-NY), other key Democrats, the DCCC, and the DSCC have received large chunks of change from key healthcare industry lobbyists, and even if it is implicitly, this money and regular access being given to healthcare lobbyists certainly leads to politicians folding on campaign promises and giving big pharma what they want.

It should come as no surprise that I am an advocate for a single-payer, universal healthcare system. The principle that creating a monopsony would lower healthcare costs for everyone, ensure all are covered and end the days where health insurance is a for-profit business seems obvious to me.

Still, I dream of the days in the 2020 Democratic primary where there was at least a regular discussion over whether we should implement a single-payer system or a still-respectable public option. Instead, corruption has left us with mostly the same system we had when President Biden took office over a year ago, with little indication that substantial improvements are on the way. If we want to see robust improvements to our healthcare system — which polling suggests we do — we should spend time not just discussing how far our healthcare proposals should extend, but how we can ensure all of our voices are heard, not just the voices of healthcare companies and their lobbyists.