Date of Award


Document Type

Open Access

Degree Name

Bachelor of Science


Political Science

First Advisor

Mark Dallas


Health care, insurance, election, presidential, United States, Medicare for All, public option, Medicaid, social programs, free, Trump


How much longer can the United States remain the only developed country without universal health insurance? While the U.S. leads the world in healthcare costs per capita, it trails behind in access and quality measures. Many Americans live in fear of medical bankruptcy, especially the twenty-six million people who remain uninsured. The Democratic presidential candidates vying for the nomination in 2020 have released plans to resolve these problems and bring the nation closer to universal coverage.

Through the analysis of proposed actions, plan feasibility, and expected impact, the candidates’ suggestions have been evaluated within the context of the United States. This study will show that all of the Democratic candidates with internally coherent platforms fit into one of three categories: 1) Medicare for All enthusiasts, who advocate for a single-payer system, 2) Affordable Care Act defenders, who favor a new public insurance option, and 3) business-as-usual believers, who do not make health insurance their reform target.

This study will also demonstrate the need for universal healthcare. It will show that inequities in healthcare delivery—denying some Americans access on the basis of socioeconomic status—is the reason why the current healthcare system is able to function. Furthermore, it will submit that the gold standard to remedy this problem is a single-payer system. A single-payer system such as the one proposed in by the Medicare for All Act will remove cost-sharing measures, allowing all Americans to access important preventative health services and seek treatment when needed. It also will alleviate overhead insurance costs which result from the nuances of filing insurance claims with a mixture of private and public programs.

However, the current U.S. healthcare industry is not ready for Medicare for All. There already exists a shortage of physicians in the United States; if everyone could access healthcare, the U.S. would need about 95,900 additional physicians.[1] For this reason, the U.S. must prepare for a single-payer system by maintaining its current healthcare workforce and by expanding education and training programs for future healthcare workers.

Despite increased public support for universal healthcare, even a single-payer system, several prohibitive factors exist. Lobbying organizations from the healthcare industry and the private insurance industry, both of which tend to dislike the expansion of government programs, have been influencing the legislative process. These organizations also release attack advertisements which can mislead the public on the intentions of healthcare insurance reform plans. Finally, Congressional support for universal coverage remains low, even for more moderate options such as the addition of a buy-in public insurance program. These factors make the potential for fast, sweeping reform unlikely.

The U.S., however, must soon incorporate changes to its health insurance. It currently lags behind the rest of the world in both access and quality measures, despite spending more on healthcare per capita than any other nation. As healthcare premiums rise faster than wages, a greater proportion of American incomes will need to go towards healthcare spending. Leaving insurance the same will prolong, and potentially aggravate, the cost burden Americans face when they become sick.

[1] Dall, et al,. “The Complexities of Physician Supply and Demand: Projections from 2017 to 2032.” Association of American Medical Colleges by IHS Markit Ltd. 2019, 41



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