This article was originally published in our Fall 2020 print issue.

The 2020 election season is drawing to a close, and as television screens daily illuminate with political news, Americans listen to the Republican and Democratic parties’ unique versions of various policy goals. After a passionate primary race among the Democratic candidates, Joe Biden prevailed as the nominee for the Democratic party. Despite this, the controversies contested by the candidates throughout the Democratic debates remain relevant even after election season. One controversy — whether healthcare is a human right or a commodity — debates whether healthcare is a need that should be regulated by the government or a choice that should be regulated by the marketplace through supply and demand. 

According to the Kaiser Family Foundation (KFF), the direction the government takes toward healthcare can affect the health insurance coverage of millions of Americans everyday, and uninsurance has serious implications on Americans’ health and financial well-being. Specifically, KFF explains that uninsured Americans face increased health costs, causing many of them to postpone or cancel health care altogether and leave preventable or chronic conditions undetected. When people who are uninsured do seek care, they experience unaffordable medical bills that exacerbate medical debt rates. According to the Peter G. Peterson Foundation, compared to the rest of the world, the United States spends a disproportionate amount on healthcare, yet, as a whole, the United States’ healthcare system has seen poor health outcomes. In fact, about 27 million Americans remain uninsured despite the government’s high costs of healthcare spending. As minimal funding is allocated to long-term or preventative healthcare, it becomes clear that the United States’ healthcare system needs improvement, and the Democratic candidates during the primary election season were eager to tackle the healthcare problem. 

While the Democratic candidates offered contrasting healthcare policy goals, this article focuses on two Democratic candidates in the race, Bernie Sanders and Biden. Democratic candidate Bernie Sanders, before conceding the final Democratic nominee spot to Biden, fought for universal healthcare. Biden, a more centrist Democratic candidate, advocates for individuals’ rights to decide their own healthcare plan. While Sanders and Biden advocated for health justice and health coverage for all, their plans differed in significant ways and posed varying financial and health-related implications.

Sanders’ “Medicare for All” campaign proposed a single-payer, national health insurance program that would provide Americans with comprehensive health care coverage, while Biden argues that those who prefer an alternative to Medicare should be able to choose a separate or a private insurance plan. Both Sanders and Biden agree that the consolidation of pharmaceutical companies, health insurers, and hospitals has increased prices without improving the quality of health services. In fact, “the global pharmaceuticals market was worth $934.8 billion in 2017 and will reach $1170 billion in 2021, growing at 5.8%,” according to a recent pharma market research report by the Business Research Company. Sanders explained that while the average American pays an excessive amount for premiums, deductibles, copays, and other out-of-pocket expenses, the wealthiest one percent of Americans and multi-millionaires pay little in taxes. In response to the pharmaceutical industry, Bernie Sanders’ plan proposed a one percent tax on individuals who make $32 million in income and up to an eight percent tax on individuals who make over $10 billion. This separate wealth tax, in addition to tax increases on both large businesses and the wealthiest individuals in the country, would have funded Sanders’ healthcare plan, saving middle-class Americans from the need to pay additional taxes. Although Biden does not advocate for a separate wealth tax, Biden explains he will fund his healthcare plan by raising the country’s top individual income tax rate from 37 to 39.6 percent and the corporate tax rate from 21 to 28 percent, according to the Tax Foundation website. Similarly, Biden’s healthcare plan would not only be funded through corporate taxes and spending cuts but also through the money gained by the breakdown of the pharmaceutical company conglomeration. Broadly speaking, Sanders’ plan for Medicare for All favored taxing big, wealthy businesses, as well as eliminating for-profit pharmaceutical corruption, while Biden stands behind former President Barack Obama’s Affordable Care Act and affirms that building on the ACA, in addition to giving Americans a choice, will reduce healthcare costs and increase healthcare coverage.

Bradley Heinz, a joint graduate student at the Berkeley School of Public Health and joint medical student at the University of California, San Francisco, is a member of the Students for National Health Program (SNaHP)—an organization that advocates for single-payer health insurance. Since learning about health disparities in the U.S. through an article he read in a public health course called “Improving the Prognosis of Health Care in the USA” by Galvani et al., Heinz says that health disparities in the U.S. are primarily driven by a lack of access to healthcare. According to the article, “40 million Americans remain uninsured, 70,000 people will needlessly die, and 500,000 to one million people will go bankrupt” due to our current health insurance plan. 

On a different note, primary care physician Dr. Phyllis Cohen supports Biden’s healthcare plan in its vows to increase access to the nation’s mental health services; such health issues are often overlooked and are in urgent need of improvement, according to Cohen. In “all tiers of medicine, mental health services are lacking, which makes practicing medicine very difficult, since much of health improvement is based on behavior changes and a sense of well-being. Mental health services are key but are often not available,” Cohen said. In addition to expanding the nation’s mental health services, Biden aims “to reverse the Hyde Amendment and increase funding to Planned Parenthood to assure that women have full access to reproductive care.” The Hyde Amendement is a legislative provision that “blocks federal funds from being used to pay for abortion outside of the exceptions for rape, incest, or if the pregnancy is determined to endanger the woman’s life, resulting in dramatically limited coverage of abortion under Medicaid and other federal programs,” according to KFF. In contrast, Trump proposed that his 2021 budget would decrease total funding toward substance abuse, mental health services, and Medicaid, claimed that his administration’s goal is to overturn the Affordable Care Act altogether, and called for the Hyde Amendment to become permanent law. 

Like Biden, Bernie vouched for comprehensive reproductive care under Medicare for All that would repeal the Hyde Amendment; “all reproductive health services [would] be provided free at the point of service,” including contraception, according to the Bernie Sanders Official Website. Dr. Cohen says that because Biden is the more moderate Democrat, he has the potential to more widely connect with moderate Americans who may not hold such frequent conversations around those issues of mental health and reproductive rights. Therefore, Biden’s plan works to address communities in America that have often been overlooked or excluded from the healthcare conversation and encourages moderates to place importance on mental and reproductive health issues in the healthcare debate.

While Heinz agrees with the importance of addressing the nation’s mental health and women’s rights issues, he says a combination plan like Biden’s would exacerbate tiered care based on socioeconomic status. As a result of such considerations, Heinz advocates for Bernie’s healthcare plan due to its financial benefits for Americans. Sanders’ single-payer system advocated would have saved “billions annually, eliminate medical bankruptcies, [provided the] greatest relief to lower income households, and [offered the] highest quality medical care for all,” Heinz said. As “insurance status is one of the main socioeconomic determinants of health,” access to primary care via a single-payer system can sustain the health of Americans, according to Heinz. 

Americans’ votes in the presidential election can determine the direction of the healthcare debate going forward. The next president faces the task of repairing a healthcare system in America that has historically created high prices for health services and left many Americans uninsured. Although healthcare impacts the country as a whole, Berkeley students and young voters may have reasons other than healthcare that motivates them to vote during election season. Despite this, long-term reform goals like healthcare plans take years to implement and will require informed citizens and voter and civic engagement to achieve change. The healthcare debate will not near an end any time soon, but citizens, as well as Biden, can learn from the various healthcare goals and strategies of the previous Democratic candidates, strive to implement their ideas into a healthcare plan that prioritizes high quality, not-for-profit health insurance coverage for all Americans, and work to restore the democratic values that have crumbled alongside the rates of health in our country.