Democrats hope health will stand to them in tough midterms

America Letter: Healthcare is divisive in the US, but Obamacare has grown in popularity

The United States offers some of the best healthcare available in the world, if you can afford it.

The country has some of the finest doctors, the most comprehensive hospitals and medical facilities and some of the most brilliant researchers anywhere.

However, healthcare in the US comes at a very high price. In 2020 healthcare spending reached $4.1 trillion or $12,530 per person. And recipients must work their way through a thicket of insurance plans that form part of the US’s bewildering systems of co-payments and deductibles.

Healthcare is rarely far from the news in the US, but there were two significant developments over the past week or so.


Firstly the House of Representatives approved a Bill that would cap the out-of-pocket costs of patients who needed insulin at $35 (€32) a month for most Americans.

Insulin, a life-saving drug that is typically taken daily, has grown increasingly expensive in recent years, and there are concerns that some patients are rationing their use or ceasing to take it due to the costs involved.

Extraordinary as it may seem, at present patients with diabetes are paying on average about $375 for insulin, with some having to fork out up to $1,000 per month

President Joe Biden, in his state of the union address last month, said insulin cost pharmaceutical companies about $10 a vial to make but that companies were charging patients up to 30 times that amount.

Extraordinary as it may seem, at present patients with diabetes are paying on average about $375, with some having to fork out up to $1,000 per month.

However, before it would become law, the proposed new cap would have to pass through the Senate, where it would need the support of 10 Republicans.

Democrats had originally wanted a far more ambitious medicines package that would limit price rises on all prescription drugs and for the government to use its bulk-purchasing power to negotiate directly on the cost of some products.

Other parts of such a broader Bill would have expanded health insurance coverage and extended insulin coverage to diabetes patients who are uninsured – an issue the Bill passed by the House last week would not address.

Republican objections

A congressional report last December suggested that Medicare, the US government health insurance programme for those aged over 65 and the disabled, could have saved more than $16.7 billion from 2011 to 2017 on insulin purchases if it had been allowed to negotiate discounts with drug companies.

However, some Republicans argue that allowing the government to use its muscle to try determine prices would amount to socialised medicine and would impact on the future development of new products.

Needless to say the bio-pharmaceutical industry was not wild about the idea either. It warned against “dangerous policy experiments” that would “threaten patients’ access to medicines and sacrifice future medical advances”.

The second major health-related news event this week centred on the return of Barack Obama to the White House for the first time since he handed over power to Donald Trump in January 2017.

He was there to mark a move by Joe Biden to fix an element of the healthcare law first introduced by Obama.

Obama said the passing of his Affordable Care Act represented the high point of his time in office. He said he had been determined to get the measure introduced even if it cost him re-election.

Despite the fact that the US’s healthcare system didn’t work well and millions of people did not have insurance, it was hard to introduce change, he said.

“Healthcare represents about one-fifth of our economy; that’s trillions of dollars that are involved. So there were a lot of different economic interests that were vying to maintain the status quo.

“And because the majority of Americans did have healthcare, some people naturally worried that they’d lose what they had. The media was sceptical of past failures. There was a lot of misinformation – to say the least – flying around. And it’s fair to say that most Republicans showed little interest in working with us to get anything done.”

Growing support

In fact Republicans were far more than unsupportive. They tried to repeal the Act and took cases to the supreme court to have it thrown out.

Despite all the criticism, Obamacare would appear to have grown on Americans. Polls suggest the scheme is now viewed favourably by about 55 per cent of adults – although support is much lower among Republicans.

The growing popularity of Obamacare offers Democrats another issue on which to campaign

A record number of Americans – about 14 million – have signed up for health plans through the Act’s marketplaces for 2022. The rise appears to stem from reduced cost of insurance as a result of financial assistance on offer under Covid stimulus initiatives, greater promotion of the scheme by the Biden administration and disruption to traditional employer-provided insurance arrangements caused by the pandemic.

The Democrats face a tough election this coming November. The growing popularity of Obamacare offers them another issue on which to campaign and to warn about what the Republicans might do if they take back power. Which is probably why Obama was wheeled out for the big photo opportunity at the White House this week.