Vice President Mike Pence forced to cast the tie-breaking vote on moving forward with the senate healthcare debate.
New York City – Americans, it seems, have argued a lot about healthcare in recent years.
Anybody who thought this week’s collapse of the latest Republican bid to scrap the 2010 Affordable Care Act (ACA), better known as Obamacare, would draw a line under this long-running dispute will be sorely disappointed.
The Republican party of US President Donald Trump is already planning another swipe at Obamacare in October 2018 – the next time the US Senate can pass fast-track finance laws with a slimmer majority than usual.
Meanwhile, some key Democrats are getting behind plans for a government-run universal healthcare system to cover all Americans, akin to schemes familiar to citizens of richer European and Asian countries.
Campaigners increasingly say a switch to European-style universal healthcare in the United States is “inevitable”, that Obamacare has whet public appetite for an all-inclusive medical scheme and politicians are getting on board.
“The case for universal, federal healthcare is advanced, and we’re close to winning, but this last inch needs the most work and is where we face the greatest resistance,” Benjamin Day, director of advocacy group Healthcare-NOW!, told Al Jazeera.
He credits Bernie Sanders, the Vermont socialist whose surprise wins in Democratic primaries for the 2016 election race challenged the assumption that leftist views on tax and healthcare were anathema to Americans.
This month, Sanders released his Medicare for All Act, which would expand a government-run, tax-funded healthcare scheme – known as Medicare – that currently benefits everyone aged 65 and older, to Americans of all ages.
Sanders, who did not respond to Al Jazeera’s invitation for an interview, said it was time for the US to “join the rest of the civilised world and guarantee healthcare as a right for all people”.
He outlined a “single-payer” national health insurance scheme, in which the government collects taxes and uses them to pay hospitals and clinics – which would remain largely in private hands – for all necessary medical services.
The government could fix prices and save “billions of dollars a year in medical administrative costs”, Sanders said. A bloated insurance market has maximised profits, so the US spends $10,000 on healthcare per person each year – double that of Britain, Canada, and other rich countries.
It marks a big departure from former President Barack Obama’s signature ACA policy, which helped millions of Americans buy private insurance schemes and made many others eligible for government-funded treatment, but stopped short of providing universal coverage.
The Centers for Disease Control and Prevention says 28.2 million people – or 10.4 percent of the US population – remain uninsured after Obamacare. They either go without treatment or have to open their wallets every time they visit a doctor or pharmacy.
At present, Sanders’ Medicare for All Act is a non-starter. It lacks support even among Democrats in the Senate, would never make it through the House, and President Trump would doubtless refuse to sign it were it to ever reach his desk.
But campaigners note that among the 16 co-sponsors of Sanders’ bill are perhaps all the prominent Democrats who are positioning themselves to seek their party’s nomination for a White House run in 2020.
They include three reformist senators – Elizabeth Warren of Massachusetts, New Jersey’s Cory Booker, and Kamala Harris of California. Another would-be contender, New York Governor Andrew Cuomo, recently called single-payer healthcare a “good idea”.
As such, Day and others predict that in November 2020 voters will be choosing between a Democrat who supports single-payer healthcare and Trump – or another Republican – who is dead set against such socialist-style policies in the US.
“That’s an election I’d love to see,” said Day, who was left almost bankrupt in the 2000s when his health insurer refused to pay his medical bills after a series of anxiety attacks landed him in hospital.
Both sides in this debate scour opinion polls for guidance.
A Pew Research Center survey in June found 60 percent of Americans say the federal government should be in charge of ensuring all citizens get healthcare coverage, while 39 percent say it’s not the government’s job.
The public may be swinging in Sanders’ direction. Overall, 33 percent of Americans favour single-payer health insurance – a marked increase on the 21 percent who backed the idea in 2014. Other polls make similar findings.
That, of course, may not swing a presidential vote and – even if it did – would not mean a reform package would make it through Congress without a dogged fight from Republicans and a powerful and well-funded healthcare lobby.
As such, other healthcare reformers are less sure of their prospects.
For Adam Gaffney, author of To Heal Humankind: The Right to Health in History, the US has only reached “the end of chapter two in a six-chapter book” that has the happy ending of single-payer healthcare for all Americans.
“There’s still a long way to go, but politicians are coming around,” Gaffney told Al Jazeera.
It’s hard to explain why the US stands alone on healthcare in the developed world, said Day.
Universal national healthcare systems gained traction in the 1940s, with the notable creation of Britain’s National Health Service (NHS) in 1948. European countries followed suit, and by the 1990s such schemes had reached Canada, Australia, Taiwan, South Korea and Israel.
Americans were unimpressed. They are culturally more averse to taxes and state-run bureaucracy than Europeans, and opportunities to get the White House and both tiers of Congress to agree on a big social reform are few and far between.
Back when Britons created the NHS, healthcare was low-tech and cheap. Medicine has made huge strides in recent decades, but it has also become more costly. Americans now baulk at the idea of switching to a single-payer system with such eye-watering tax implications, said Day.
Jane Orient represents the libertarian end of the debate. She agreed that healthcare costs are puffed up by insurers and drug-makers, but also rejected Sanders-style “socialism and coercion” into government-run tax schemes.
She would turn back the clock to the 1940s. Going to the doctor would be much the same as buying groceries – sick folks would reach for their purses each visit, meaning doctors and hospitals would have to charge competitive rates.
“The US has had a tradition of freedom and individual responsibility and has seen the horrible results of socialism when it’s fully implemented,” Orient, director of the Association of American Physicians and Surgeons, an advocacy group, told Al Jazeera.
“And they look to see all the vaunted, wonderful results from the UK and Canada are not as rosy as they first appear, and they too are supported on a foundation of deficit financing that is not sustainable.”
With such diversity of opinion, US politicians are doubtless a long way from agreeing on what Americans should do when they get sick – and who pays the bills. For his part, Trump appears eager to end a decades-old wrangle.
On Wednesday, he told reporters of wide-ranging plans to sign an executive order, to revive Obamacare repeal efforts in the spring, and to cut deals with both ends of the political spectrum – libertarians and Democrats.
It seems that, on healthcare, the president is becoming as split as his countrymen.
Follow James Reinl on Twitter: @jamesreinl