On the other side of the Atlantic, several subjects dominate the political debate head and shoulders. On the platforms and on the television sets, it is only a question of “out of control price hike”of “Mexican border crisis” or « wokisme ». However, poll after poll confirms that one of the major concerns of Americans is an old nagging subject: health.
Health, a more pressing problem than immigration or unemployment
For 64% of respondents, according to a Pew Research Center survey published in Junethe cost of medical expenses is a “very important problem” in the United States – just behind inflation (65%), but far ahead of illegal immigration (47%), terrorism (30%) and unemployment (24%).
In America already campaigning for the 2024 presidential election, the staggering costs of private health insurance and the failures of one of the most expensive health care systems in the world are relegated to the background. “This will probably be the first presidential election since 2008 where health reform will not dominate the debates”recently wrote Larry Lewitt, senior official of the Kaiser Family Foundation, a major American NGO dedicated to health issues.
Few new proposals on both sides
It is true that the two camps have little to offer. On the Democratic side, Joe Biden is campaigning for adjustments to the margins of Obamacare, the health reform adopted in 2010, when he was vice-president. He does not have to face a candidacy on his left which would relaunch the debate on a “health for all”, European style. If Joe Biden has taken measures to lower the price of drugs, it is still too early to flatter himself on results in this area.
On the Republican side, we are frankly embarrassed. And for good reason: the proposals are rare. Since 2008 and Barack Obama’s victory, the vision of the American right has boiled down to frontal opposition to the Democratic president’s project, then, once Obamacare has been adopted, to the promise of its reconsideration. Before making the observation, in the time of Donald Trump, of the absence of an alternative project. “Nobody knew that health could be such a complicated subject”, had dropped Donald Trump in early 2017, acknowledging the impasse. And seeming to ignore that the law promulgated by Barack Obama was more than a thousand pages…
The success of Obamacare, a historic reform
Historical without being revolutionary, Obamacare has not changed the system, which still relies mainly on private actors. But by forcing Americans to insure themselves for their health with a mechanism of subsidies and penalties, and forcing companies with more than 50 employees to offer medical insurance to their employees, the reform has made it possible to see the number of Americans not insured decline sharply, from 15% in the early 2010s to 8% today.
In the name of the defense of freedom, the Republicans opposed these new constraints. But also to the other important component of Obamacare: the expansion of Medicaid, the public coverage of the poorest set up in 1965 and financed jointly by the federal state and by the federated states. Before Obamacare, only people whose incomes were below 64% of the federal poverty level could benefit, compared to 138% today.
Fiercely opposed to this expansion, the Republicans were forced to let go of the popular support for this initiative, confirmed in local referendums. “It is no longer a subject of polarization as in the pastexplains Robert Saunders, director of research at the Margolis Center for Health Policy at Duke University. A few years ago, it was a big topic of tension. This is a good thing for the United States. » Today, 40 out of 50 states have accepted Medicaid expansion. Even very recalcitrant states, such as Louisiana or Oklahoma, rallied to Obamacare.
2023-07-28 04:28:05
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