For most of us healthcare, both for ourselves and our loved ones whether juniors or seniors, is one of our highest priorities.  Our politicians, whether Republican or Democrat, recognize this and put healthcare, (as represented by the Affordable Care Act, or Medicare in all its Parts. A, B, C, and D), in the forefront of their election campaigns.


The republican party, while growingly sympathetic to the public’s increasing support for the Affordable Care Act (ACA) and Medicare in general, is keeping a low profile while the democrat candidates argue in public.

Broadly, across the political spectrum there is agreement on four main issues: –

  • The cost of healthcare in the USA is significantly higher than in peer group countries
  • The outcomes are no better and, in most cases, worse than in comparable developed economies
  • Healthcare service is not evenly available across all states and counties nor across socio-economic groups (zip code lottery)
  • Funding must be reviewed to achieve a better balance between individual and corporate tax payers.

Of course, there is a range of solutions on offer: –

For the Administration, the proposed solution is the ‘block grant’ to individual states.  By devolving the budget to the fifty autonomous states the administration relieves itself of its major fear – the exposure to potentially unlimited demand and thus unlimited expense.  This approach does nothing to resolve the issues of efficiency or effectiveness and almost certainly will increase the friction induced by the ‘zip code’ lottery!

For the Democrats Joe Biden and Bernie Sanders (see Bernie Sanders and ‘Medicare-for-all Explained’) are outlining programs with similar aims.

Bernie Sanders ‘Medicare-for-all’ will replace Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D, with a single ‘one-payer’ (the federal government), with a ‘free-at-the-point-of-service’ national health insurance program.  For whatever reason, there is a general reluctance among providers, pharmaceutical companies, and the voting public to embrace what seems to be ‘mandatory’ health insurance. 

JOE BIDEN, by contrast, faced with the same landscape, and listening to public opinion, rejects Bernie Sanders’ ‘Medicare for all’ concept. Instead he proposes to introduce a ‘public option’ to choose a government-run health insurance plan to compete with the private insurance market. 

By using the purchasing power of an enlarged Medicare organization, and increasing the competitiveness of the insurance market he hopes to reduce the cost of all health insurance plans without explicit rises in taxation bearing on the middle classes.  This is NOT Joe Biden and Medicare for all, but Biden is confident that lower costs will attract a significant reduction in of the 28 million+ U.S. American citizens who are not currently insured (U.S. Census Bureau) to join health insurance plans.

Around 28% of working-age adults i.e. approximately 41 million people are under-insured (The Commonwealth Fund).  BidenCare is expected to offer these citizens better coverage for their premium and a choice between their existing plans and the ‘public option’.

In common with his rivals for the Democratic nomination, Biden intends to clamp down on two aspects of the ACA and current legislation which bear heavily on the average citizen

  1. Surprise” Medical bills
  2. Excessive pricing of prescription drugs.

Surprise medical bills

We have discussed this problem elsewhere (see when is a ‘Surprise not a Surprise’), but briefly it is when a patient is billed for a service which they had no ability to avoid, e.g. ER (in-network vs out of network).

Biden proposes to limit such charges, such as in ER when a patient may have no choice over which provider(s) he/she sees or is treated by.

Excessive pricing of prescription drugs

Leaving aside the pharmaceutical companies’ justification for their pricing policies, the fact remains that American citizens pay anything from 1.5x to 3x as much for prescription drugs as citizens of comparable countries.

Biden proposes to: –

  • Allow Medicare to negotiate bulk purchasing discounts
    • Allow consumers to buy drugs from abroad (subject to FDA regulations)
    • Limit prescription drug price increases to the rate of inflation
    • Foster ideas to increase the production of generic medications
    • Stimulate competition among providers by blocking provider concentration.


Joe Biden’s proposals are not entirely unacceptable to the health care industry in which profit driven enterprises play a significant part. After all he offers a potential growth in the market and a leveling of the playing field on which some may lose but a market expansion from which many may gain.

The greatest gainers should be the paying public, whether their health insurance is paid for personally (out of pocket), through insurance (individual or employer), or though taxation.

For more information see our article: DOES PRESIDENT TRUMP REALLY WANT TO REPEAL THE ACA?