Health advocates and progressive Democrats have revived calls for the US to consider expanding Medicare to millions of Americans during the coronavirus pandemic, while the White House threatens the federal health programme and Democrats draft their vision for the next four years in the party's 2020 agenda.
The US public health emergency from Covid-19 has laid bare several institutional crises, renewing calls for a nationalised healthcare system, free at the point of service, to address inequities in care along the long road to the nation's recovery.
Medicare for All proposes opening the publicly financed federal Medicare programme to all Americans and eliminating a for-profit insurance market, which critics argue has created administrative hurdles for providers and inconsistent and unequal coverage and billing for patients. Under a nationalised healthcare system, Americans wouldn't lose coverage if they left a job or face massive hospital bills.
In a column published by USA Today last week, Khati Hendry – an American physician who moved to Canada in 2004 – said she has "never felt more grateful to work in a universal healthcare system than during the Covid-19 pandemic".
"My heart aches for the millions of Americans who have fallen ill and then have had to worry about how they will pay for tests and treatment, who have gone to work while sick for fear of losing their health coverage or who have lost not only their jobs but their insurance, leaving them at risk for financial ruin," she said.
Canada has confirmed more than 120,000 coronavirus cases, while the US has surpassed 5 million.
"Its health system has two big advantages when fighting the pandemic: universal health coverage and an administratively simpler system," Dr Hendry said.
Her US colleagues are "burned out from administrative demands and anguished from seeing patients not get the care they need because of cost," she added.
"Now it is worse, as the number of uninsured has soared with the pandemic," she said. "My message for them is this: I know we can do better, because I see it every day. It is worth fighting for a system that puts public health ahead of profits: Medicare for All."
Washington congresswoman Pramila Jayapal, sharing the column on social media, said: "Let's make it happen."
The congresswoman endorsed Medicare for All legislation in 2019. The bill has 118 cosponsors.
Along with Bernie Sanders, whose Medicare for All pitch was central to his 2016 and 2020 presidential platforms, she also introduced the Health Care Emergency Guarantee Act to "fully cover the cost of medically necessary healthcare, including prescription drugs" for uninsured Americans through the duration of the coronavirus public health crisis.
Despite broad popularity among voters, Democrats ultimately rejected Medicare for All in its 2020 agenda ahead of the party's convention in August.
The platform draft says the party should instead work to "protect, strengthen, and build upon our bedrock health care programmes, including the Affordable Care Act, Medicare, Medicaid, and the Veterans Affairs system." The draft endorses a "high-quality, affordable public option through the Affordable Care Act marketplace" to be administered by the government, but the US healthcare system still primarily would rely on healthcare companies to provide care for most Americans.
Presumptive presidential nominee Joe Biden also has supported expanding a public option but does not endorse replacing the current health system with Medicare.
A group of more than 700 delegates have pledged to reject any party platform that does not include Medicare for All, pointing to the urgency of the pandemic.
"Millions of Americans have lost their healthcare insurance because of those job losses at a time when healthcare is needed most," the group wrote.
"The Democratic Party and their Platform Committee process has failed, to date, to incorporate a clear and progressive platform plank" to adopt Medicare for All as part of its 2020 platform, according to the group.
The four former co-chairs of Senator Sanders's campaign – former Ohio state Senator Nina Turner, Congressman Ro Khanna, San Juan Mayor Carmen Yulin Cruz and Ben & Jerry's co-founder Ben Cohen – applauded the effort, urging that "now is the time to reclaim the legacy of the Democratic Party, which sought healthcare for all starting with [Franklin Delano Roosevelt] and Harry Truman but lost its way beginning in 1980 when Medicare for All was stripped from our party's platform."
An estimated 5.4 million Americans lost their health insurance from February through May, according to the Kaiser Family Foundation. Unprecedented unemployment and layoffs following forced business closures in the outbreak's economic fallout have accelerated the coverage loss.
Another 27 million people are at risk of losing coverage through the pandemic, according to the foundation's report. Another 28 million Americans didn't have any insurance last year. Factoring in the number of uninsured Americans – people who receive some coverage but whose out-of-pocket costs exceed 10 per cent of the income – and that figure climbs to more than 84 million.
While many Americans are eligible to enrol in coverage plans through the Affordable Care Act marketplace or Medicaid, gaps in coverage and associated cost barriers to buying insurance are more likely to impact Americans of colour.
Those obstacles are compounded by the lack of health services in low-income communities.
An August report from Health Affairs found that 49 per cent of the lowest-income communities had no intensive care unit hospital beds, compared to only 3 per cent in the highest-income communities, amid the pandemic.
"Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the Covid-19 pandemic on mortality rates in low-income communities.
Democrats and some Republicans have condemned Donald Trump's latest executive orders, claiming that the president is attempting to bypass Congress after Republicans stalled coronavirus relief negotiations.
The orders would cut back additional unemployment benefits the government provided during the pandemic to $400 a week and provide a payroll tax holiday for Americans who earn less than $100,000 annually, which the president said he would forgive if he was re-elected in November.
Senate Minority Leader Chuck Schumer said the president's payroll tax holiday essentially "depletes money out of the social security and Medicare trust funds".
"If you're a social security recipient or Medicare recipient, you better watch out if President Trump is re-elected," Senator Schumer said.
Ben Sasse, one of the rare Senate Republicans who has spoken out against the president despite receiving his endorsement, called the orders "unconstitutional slop" in a statement sent to The Independent.
"The pen-and-phone theory of executive lawmaking is unconstitutional slop," the statement read.