Senator Bernie Sanders may walk tightrope for healthcare reform

The US’s leading advocate for healthcare reform is in pole position in Congress to advance his agenda. Bette Browne reports

Senator Bernie Sanders, a former US presidential hopeful and self-described democratic socialist, has won the leadership of a powerful congressional panel. He plans to use it to champion access to affordable healthcare for all Americans.

Senator Sanders, who votes with the Democratic party in Congress, but is an independent senator representing Vermont, shot to international prominence during two failed bids to become the Democratic party nominee in the 2016 and 2020 US presidential elections.

In both campaigns, he denounced the deepening economic and social divide between rich and poor in America and promised to create a single-payer national health insurance programme, which he dubbed Medicare-for-All. At present, the popular government-supported Medicare insurance programme covers only older persons.

Radical

Senator Sanders’ rallies and his reformist agenda drew huge crowds. In 2016, he came close to defeating Ms Hillary Clinton as the party’s presidential candidate.

In his second bid for the Democratic nomination in 2020, the then 79-year-old Senator seemed to have lost little of his passion for radical change, especially in healthcare. In a speech on 17 July 2019, televised by the C-Span network, he declared before a cheering crowd that “doctors and nurses and other healthcare professionals understand we cannot continue with the current dysfunctional healthcare system”.

“They increasingly understand healthcare is a human right, not a privilege,” Senator Sanders added. “Today we come together to end the embarrassment of America being the only major country on earth not to guarantee healthcare to every man, woman, and child. We will end the embarrassment.”

He went on to denounce the fact that health insurance was unaffordable to millions of Americans.

“It is not acceptable to me nor to the American people that some 87 million Americans are either uninsured or are underinsured. It is not acceptable to me that we end up spending almost twice as much per capita on healthcare as do the people of any other nation, while at the same time, our life expectancy continues to go down and our healthcare outcomes lag behind other major countries.

“Under the dysfunctional healthcare system we have today, 30,000 Americans every year are dying because they don’t go to the doctor when they should because they lack health insurance or they are underinsured with high deductibles or high co-payments. This is the United States of America (and) 30,000 people a year should not be dying because they lack adequate health insurance. I am sick and tired of seeing working-class families and small businesses pay far more than they can afford to pay and 530,000 Americans declare bankruptcy each and every year because they cannot pay off the outrageous cost of a medical emergency or hospital stay.

“They shouldn’t be driven into financial ruin because someone in the family becomes ill. People shouldn’t be forced into financial ruin or bankruptcy because they cannot face the unbelievably high cost of prescription drugs. Can you believe that in America today people are dying because of the high cost of prescription drugs.”

The more he denounced the system the more popular his rallies became, especially when he took aim at what he called the “greed” of pharmaceutical companies. “We will no longer accept the greed of the pharmaceutical industry,” he declared, citing the fact that in Canada insulin could be purchased for one-tenth the price that patients were charged in the United States.

“So today we tell the pharmaceutical industry their greed is going to end. We are tired of getting ripped off. Nobody thinks that the system in which 80 million people or more have no health insurance or are underinsured is a good system. Nobody I know thinks that when Americans are paying the highest prices for the world for prescription drugs that that is a good system.

“This has nothing to do with healthcare, but it has everything to do with the greed and the process of the healthcare industry with the medical equipment supplier, Wall Street entities, that make tens and tens of billions of dollars every single year while ignoring and turning their backs on the needs of the American people. It’s about whether we maintain a dysfunctional system that allows the big drug and healthcare companies to make over $100 billion in profit last year. All the while one-out-of-five Americans cannot afford to get the prescription drugs that their doctors prescribed. The function of a rational healthcare system is to provide healthcare to all in a cost-effective way, not to make billions in profits from the insurance companies.”

His Medicare-for-All insurance plan remained popular among a majority of Americans, especially as the Covid-19 crisis began to decimate the country and millions of unemployed people started to lose their employee-based health insurance due to the economic fallout of the pandemic. In a Hill-Harris X-poll during the pandemic, for example, 69 per cent of registered voters supported providing Medicare to every citizen.

In many ways, Senator Sanders was a new phenomenon in a country where radical and progressive voices are few and far between in politics. Because of this, Senator Sanders was variously dubbed a firebrand, radical, socialist, or communist, mostly by Republicans, but sometimes by centrist or conservative Democrats.

Many in the Democratic party felt in 2020, much as they had in 2016, that Senator Sanders’ agenda and style would be far too radical for voters. Findings in a poll in February 2020 by NPR/PBS/Marist backed up the idea that the socialist label could hurt him if he became the Democratic party’s candidate in its battle to deny President Trump a second term.

Soon support increased for his rival for the party’s nomination, the more moderate President Joe Biden. In March 2020 a CNN poll found 52 per cent of Democratic party supporters wanted to see President Biden win the nomination, while 36 per cent said they would rather see Senator Sanders win.

While Senator Sanders pushed for universal healthcare by expanding the government’s Medicare insurance programme to cover all Americans, President Biden favoured more incremental steps. He wanted to build on the 2010 Affordable Care Act, which he had helped President Barack Obama to secure in Congress. Now President Biden wanted to beef it up by expanding the number of Americans getting access to affordable health insurance.

The same CNN poll in March 2020 also showed that Democratic voters were split between Senator Sanders and President Biden on who would best handle healthcare issues, with 46 per cent saying Senator Sanders would do a better job and 43 per cent favouring President Biden.

In the end, President Biden won the Democratic nomination and went on to defeat President Trump in November 2020. But Senator Sanders, born in 1941 in Brooklyn and the son of a Polish immigrant, did not fade quietly into the background. On the contrary, he kept pushing for fundamental changes in healthcare.

Healthcare legislation

Senator Sanders remained an influential force within progressive politics and played a key role in moving the policies of the Democratic party to the left. President Biden relied closely on the Senator to push a $1.9 trillion Covid-19 relief package through Congress in the early months of his presidency. Senator Sanders, by then, was Chair of the Senate budget committee and the Senate passed a budget resolution authored by Sanders’ committee. This paved the way for the relief legislation to win approval in March 2021, despite not getting a single Republican vote. It contained much of what Senator Sanders wanted for American families hit by Covid, including: $1,400 (€1,300) stimulus cheques for millions of Americans; $350 billion (€323 billion) in aid to state and local governments; and $14 billion (€13 billion) for Covid vaccine distribution. It expanded eligibility to purchase health insurance to people of all incomes under Obama’s Affordable Care Act. It earmarked $64 billion (€65 billion) to help 13 million people to pay premiums over the next three years for private health insurance under the Act. It also capped prescription drug costs at $2,000 (€1,800) annually for recipients of the Medicare programme for older persons. In addition, they would pay no more than $35 (€32) monthly for insulin, which can cost families in the US hundreds of dollars.

“We pay more for prescription drugs than any other advanced nation in the world and there’s no good reason for it. For years, many of us have been trying to fix this problem, but for years Big Pharma has stood in the way. Not this year,” President Biden declared when signing the legislation. “This year, the American people won and Big Pharma lost.” 

Senator Sanders must have been pleased. It could have been a speech right out of his playbook.

But the Senator was less happy a year later when another major piece of legislation pushed by President Biden was passed in August 2022. Senator Sanders believed this was not ambitious enough on healthcare. He had proposed a number of amendments that would have extended a childcare tax credit, provided dental and vision care to some Medicare recipients and capped the cost of prescription drugs, but each of his amendments were defeated. Despite this, however, Senator Sanders decided ultimately to vote for the Bill, which passed dramatically in a 51-50 tally, with Vice-President Kamala Harris casting the tie-breaking vote.

Health, education, labour, and pensions committee

In many ways, it was a turning point for Senator Sanders. His politics was becoming more pragmatic and such pragmatism could serve in pushing his agenda as the new leader of the Senate’s health, education, labour, and pensions committee (HELP). Leading the panel gives him a powerful platform from which to focus on reducing the cost of prescription drugs, income inequality, and student and medical debt.

His health committee has sweeping jurisdiction over America’s public health agencies, the Food and Drug Administration and other aspects of federal health policy. Senator Sanders may also take on issues, such as the health impacts of climate change.

But he won’t have it all his own way. He will have to try to win Republican support and even the backing of some Democrats who regard some of his policies as too far to the left of the party. After the last congressional elections in November 2022, however, centrist Democrats, such as Senator Jo Manchin of West Virginia, do not hold as much power over the party’s agenda. A two-seat majority margin will give Sector Sanders more breathing room to push for passage of legislation out of the committee into the full Senate, where previously it had been a 50-50 split between Democrats and Republicans.

But before legislation goes to the President for signing it must be passed by both Houses of Congress, so it will be a different story in the House of Representatives, where Republicans now hold the majority. Indeed, the new Republican leader in the House, Speaker Kevin McCarthy, has already said Republicans will seek to roll back key provisions of the Democrats’ landmark climate and healthcare bill that was passed in August last year.

Senator Sanders will also face strong opposition in the halls of Congress from powerful lobbyists for pharmaceutical companies and others in the industry. “The prospects of a Sanders-led HELP committee are refreshing and exciting,” Mr Craig Holman of the consumer rights group Public Citizen told Politico. “The Chairman will give everyone their due, including lobbyists representing the public’s interest, without being swayed by campaign cash. Sanders’ new leadership position will help build some equity between the influence of the haves and have-nots.”

While focusing on ways to advocate for his Medicare-for-All plan, Senator Sanders also plans to move ahead aggressively to tackle the high cost of prescription drugs. In an interview with the Washington Post in January, he said he would focus particularly on lowering prescription drug prices, expanding primary care, bolstering the health workforce, and beefing up rural healthcare.

In the end, Senator Sanders’ pragmatism may see him working towards incremental gains that could become law rather than overtly advocating for his ambitious Medicare-for-All plan. He admitted as much in an interview with Politico in December 2022, before taking up his post. “I’m going to be walking a tightrope,” he said. “I want to work with Republicans on issues where we can make progress. In other areas, they’re not going to support me. And I’m not going to give up on those issues. There are some issues that will have zero Republican support that I will fight for,” he added.

Yet his record also shows he has the capacity to bring Republicans along with him. In 2014, as veterans affairs committee Chair, he negotiated a landmark deal with the late Republican Senator John McCain to expand healthcare access for veterans. “He’ll be a Chairman who not only is putting the spotlight on issues he cares about, but also will do a lot of good bipartisan work,” Democratic Senator Bob Casey told Politico. “His record indicates that.”

In the meantime, Senator Sanders is also said to be contemplating another bid to become a presidential candidate in next year’s race for the White House. However, he previously told CNN he would not do so if President Biden decided to run for a second term. “I think Biden will probably run again, and if he runs again, I will support him,” Senator Sanders said. In 2024, President Biden will be 81 and Senator Sanders will be 83.

Polls show many voters do not want to see President Biden run for another term. A CNN poll conducted in December found 59 per cent of registered Democrats and Democratic-leaning independents would like to see someone other than President Biden as the party’s 2024 nominee. So if Senator Sanders notches up some key victories during his term on the healthcare panel it could boost his chances of launching a third White House bid.­