Seventy-six years after an American president first proposed guaranteeing health insurance to all, the United States still has not achieved that vision — and President Joe Biden is extending the wait.
While running for president, Biden maintained that he believed healthcare to be a human right and strongly endorsed a public option, a proposal to achieve universal healthcare in the United States. Given that vast majorities of Americans support the goal of universal healthcare, this was a promising piece of the Biden agenda. Yet, the president has done very little to make the public option a reality once in office, leaving it out of his first budget proposal.
This development is extremely disappointing and provides warning of politicians who pander to voters during their campaigns but opt against delivering on their promises once in office. Going forward, we must continue to pressure our leaders to overhaul the national embarrassment that is our healthcare system and finally guarantee health insurance to all.
President Biden has been in office for seven months. He’s created budgetary proposals, issued numerous executive orders and announced major detailed plans as part of his “Build Back Better” initiative. Notably missing is a significant slice of Biden’s campaign platform: the public option.
A public option refers to a government-provided health care plan that would provide comprehensive health coverage to any American who chooses to opt into the program. The government-run plan would compete alongside private insurance companies, differing from a single-payer system in which private insurance plans would largely be abolished.
The debate between proponents of a single-payer healthcare system and a public option dominated much of the 2020 Democratic presidential primary, but candidates largely agreed on the premise that healthcare coverage should be universal, regardless of how that goal is achieved. This was a comforting consensus given that the United States is currently the only industrialized nation to not guarantee healthcare for all of its citizens.
As it stands, our healthcare system allows Americans to get sick and die of preventable diseases simply because they cannot afford private insurance. When they are forced to pay the insanely bloated prices of drugs and treatments in the United States, medical bankruptcy or other financial hardships commonly result. These costs are so high that they often discourage Americans from getting preventative treatment right away, delaying until their condition becomes a significant threat to their health and wellbeing. Biden and other Democrats rightly sought to end this dynamic, leading them to coalesce around the public option, a compromise position that would expand access to healthcare while also allowing private insurers to remain intact.
Instead of working to achieve what was then the compromise position, Biden has focused on expanding Medicare and protecting the Affordable Care Act. While these actions help low-income and elderly individuals access healthcare, they don’t ensure that all Americans will be insured regardless of if they can afford private insurance. These programs are not meant to be universal and have left tens of millions uninsured, whether that be because they aren’t eligible for aid, don’t believe any plan would be affordable for them or a multitude of other reasons.
Not only has the public option yet to become a reality under the Biden presidency, no comprehensive plan has been released for how it can even be achieved. The legislation was notably left out of Biden’s $6 trillion budget proposal focused on infrastructure, education and other aspects of the healthcare industry.
Biden’s deprioritization of the public option perhaps should come as no surprise, given that in his time as vice president, Biden wasn’t particularly enthusiastic about pursuing any comprehensive healthcare reform at all. While other 2020 Democratic candidates long supported a single-payer healthcare system, Biden opposed universal coverage in his previous runs for president.
In comparison to other leading Democrats, it’s clear that Biden hasn’t always been the most dedicated proponent of universal healthcare, which has led us to our current situation. People voted for Biden based on the belief that he would pursue his campaign promises, especially in an arena as important as healthcare, and yet he does not seem especially interested in delivering on his promise. This should teach us to favor candidates who display longstanding commitments to their principles as opposed to those who simply jump onto the party consensus; these principled figures are more likely to have the integrity to follow through with their promises when in office.
While the future of the public option seems dim at the present moment, we as voters can still apply pressure on Biden to recenter the push for universal healthcare. If released as actual legislation, the public option would face a tough battle, requiring the votes of all 50 Senate Democrats, including moderate figures like Sen. Joe Manchin, D-W.Va., in order to pass as a reconciliation bill. For Biden to garner support for a public option, he must take on these moderates, many of whom are funded by the politically powerful healthcare lobby. Healthcare companies are often hostile to universal healthcare, as their bottom lines would be threatened by a public plan that costs less to citizens and pays less to providers.
Yet, there is no doubt that Biden is the most influential figure in his party, meaning he has the capacity to reinvigorate the momentum toward the public option at the federal level, as other elected Democrats have endeavored to do, and to apply pressure on Congressional Democrats to support his version of universal healthcare, especially given its popularity among Americans.
As voters, we ought to encourage Biden to, at the very least, display his full support and attention to this extremely vital issue and further, to release a detailed budget plan that would outline how we can fund and enact a public option. Regardless of the fears that our Congress is simply too moderate for progress, it’s past time we join the rest of the industrialized world in guaranteeing healthcare to all.
Nicholas Black PO ’24 is from Rochester, New York. The United States healthcare system is one of the many things that embarrass him.
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