The healthcare crisis in America, how a twenty-eighth amendment could fix it

The coronavirus pandemic is revealing more than ever the shortcomings of the United States social safety net. In “Crisis Exposes how America has Hollowed out its Government,” Dan Balz of The Washington Post writes that “the government’s halting response to the coronavirus pandemic represents the culmination of chronic structural weaknesses [and] years of underinvestment” in the social safety net. [1]The US government has not done enough to uplift impoverished Americans and to keep struggling Americans from succumbing to poverty during the pandemic. In particular, one of the greatest social safety net weaknesses lies in healthcare. The healthcare system in the United States is incredibly broken, and its weaknesses are being witnessed firsthand by Americans during a time when they are most in need of reliable healthcare.

The pandemic is directly tied to healthcare because as businesses shut down, millions of Americans are being laid off. When nearly 50% of Americans receive employer-based health insurance, a job loss potentially means losing health insurance, too. An article by The Guardian from May 10^th cited a study by the Urban Institute and the Robert Wood Johnson Foundation that reported that between 25 and 43 million Americans could lose their health insurance during the pandemic if unemployment rates reach 20%. [2]As of May 13^th, 27 million new Americans had already lost health insurance as a result of the pandemic. [3]The Urban Institute study also estimated that around 7 million of the 43 million insurance losses would not be resolved [4]due to coverage gaps and “difficulty navigating our complex insurance system.” [5]Because the Supreme Court ruled that expanding Medicaid under the Affordable Care Act must be optional for states, fourteen states have still not expanded, leaving coverage gaps that exclude millions. While some people may be able to find insurance through ACA marketplaces, it will be difficult because there is no open enrollment period for new applicants until 2021. Trump has refused to open a special enrollment period in the 38 states with federal-run insurance marketplaces because the Affordable Care Act is an Obama Administration program that Trump has been desperately trying to eliminate throughout his entire presidency. Another option for those who have lost their employer-based insurance is to regain it through the COBRA program, though this option is unattainable for many because of the high cost; clients have to pay 102% of the full cost of their previous insurance. [6]Those whose income is not low enough to qualify for Medicaid are at a high risk of becoming permanently uninsured.

While the healthcare crisis in America has been exacerbated by the pandemic, it has long been a serious issue. In 2018, an estimated 30.4 million Americans were uninsured. [7]If 7 million Americans become permanently uninsured during the pandemic, this number rises to more than 37 million, or over 11% of the population. In addition to the high number of uninsured Americans, The Commonwealth Fund reported that 29% of Americans were underinsured in 2018, meaning that they “have high health plan deductibles and out-of-pocket medical expenses relative to their income and are more likely to struggle paying medical bills or to skip care because of cost.” [8]In addition, medical costs push half a million Americans into bankruptcy each year. [9]As mentioned previously, coverage gaps between states mean that your access to healthcare often depends on where you live, and that millions of Americans who cannot afford private insurance are not considered poor enough to qualify for Medicaid. The racial and socioeconomic inequality of the United States is prevalent in healthcare statistics as well, where “African Americans, Hispanics, and Asians… have greater uninsurance rates relative to non-Hispanic whites.” [10]High uninsurance rates compounded with the higher infection and death rates by COVID-19 puts communities of color at high risk during this time. [11]

The broken American healthcare system contradicts the values the United States was founded upon. The Declaration of Independence states that “all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.” [12]In a country where having good healthcare depends on how much money you make, people are not equal—especially with institutional racism that results in lower healthcare coverage for People of Color. The uninsured and underinsured do not have the right to life because they are forced to choose between going bankrupt or obtaining the healthcare they need. They do not have the right of liberty because their choices are limited between death and disease or bankruptcy, and they are not free to pursue happiness because they have to live with the reality that they will not be properly cared for by the healthcare system in the United States. It also contradicts the value of individualism—the idea of the US economy affording everyone an equal opportunity to be “economically independent.” [13]People do not have equal economic opportunity when they are born into inescapable cycles of poverty compounded by race, when they are bankrupted by medical costs, and when they experience debilitating health conditions caused by limited access to healthcare. If everyone had equal access to healthcare, it would help contribute to a more just economy where individualism is actually possible. Political philosopher Benjamin Crick states that “fairness” is an essential factor of citizenship education in his essay “The Presuppositions of Citizenship Education,” and that a politically literate person should ask themselves if the “distribution of goods is fair.” [14]The distribution of healthcare coverage in the United States is clearly unfair, where very few people have access to reliable and affordable health insurance and where People of Color are much more likely to be uninsured.

Healthcare has traditionally been handled by states, but the current condition of the nation is demonstrating that it’s time for the federal government to take charge. During the Great Depression, when unemployment rates reached 25%, state tax revenues decreased and states were unable to provide adequate support for the economically desperate. However, President Roosevelt was able to intervene and uplift struggling Americans with his New Deal policies because “the federal government has unlimited power to print and borrow money.” [15]These New Deal policies helped strengthen the economy because they put more money into the average American’s pocket, which they would then put back into the economy through consumerism, thereby supporting businesses, eventually creating jobs, and stimulating the economy all around.

Right now, during a similar time of economic desperation, the government should be reflecting on Roosevelt’s New Deal and prioritizing strengthening the social safety net, including health insurance. Additionally, it is the government’s responsibility to fix the United States healthcare system because the current system is not working properly. As previously discussed, opportunities for insurance coverage as well as costs vary state-by-state. A person’s wellbeing should not depend on where they live; everyone should have equal and full access to healthcare. If healthcare were federally controlled, everyone would have the same standard of healthcare, regardless of where they live. Lastly, it is the government’s responsibility because the current healthcare system is not living up to the ideals our country was founded upon and called on to maintain by the Constitution. According to Former secretary of homeland security Janet Napolitano, “a fundamental role of government is the safety and security of its people.”[16]The United States is clearly not living up to this value with 30 million uninsured and rising during the pandemic.

So, if the healthcare system in the United States is so clearly ineffective and jeopardizing the lives of many, why is nothing being done to change it? The answer is party polarization, defined as “the situation where political opinions and actions divide sharply along party lines.”[17]To understand why this is such a major issue, the legislative branch—where the issue is mostly occurring—must first be examined.

James Madison saw the Congress as the most powerful branch of government, entrusted with the power to create laws. [18]To limit this power, Congress was divided into two co-equal chambers: the Senate and the House of Representatives. There are 100 total senators, and 435 representatives. Each of the 50 states is apportioned two senators and the 435 representatives are divided proportionally according to state population. [19]Senators are elected by state voters every six years, and these elections are staggered every two years so that only one-third of senators are up for re-election at a time. Representatives, on the other hand, are elected every two years, all at once, by the voters from the congressional districts they represent. [20]The House and the Senate are made up of dozens of committees that oversee different issues, like agriculture, housing, and education. [21]

The legislative branch in the United States is made up of representatives from two major political parties: the Democratic Party and the Republican Party. This is unusual because, in most democracies, there are at least three major political parties behind which citizens can align themselves. The reason that the United States has only two major political parties is because of its single member plurality district system, a voting system “in which only the candidate who gets the most votes is elected.” Other democracies usually employ a proportional representation system, “in which legislative seats are allocated to each party in proportion to its share of the popular vote.” [22]This means that as long as every party is able to obtain at least some percentage of the vote, it will be awarded seats in the legislative body, and therefore will have political power and the ability to represent its constituents. The two-party system in the United States, caused by the single member district system, is largely responsible for party polarization.

In the Federalist #10, James Madison warned of factions, stating that political parties are “much more disposed to vex and oppress each other than to co-operate for their common good.” [23]The two-party system in the US creates party polarization by dividing political ideology between a partisan binary of liberal and conservative, which correspond to the Democratic and Republican parties. Representatives from different parties rarely agree with each other on anything because all political issues have been placed into a partisan category. Whether the House and Senate can pass any legislation largely depends on which party is in control. When Republicans control the House and Senate, Republican agenda items are passed and vice versa when Democrats are in control. When big issues arise, like healthcare, Republicans and Democrats in Congress rarely agree to compromise, and the issues remain unsolved. So how can we eliminate this division? It’s clearly urgent when the current healthcare system is contributing to poverty, low quality of life, and shorter life spans—particularly for People of Color.

The United States has always had a two-party system, but there hasn’t always been such intense political division. For example, environmental protection, a topic which is currently considered to be extremely partisan, used to be a political issue shared by both parties. As a matter of fact, it was Richard Nixon, a Republican, who founded the Environmental Protection Agency. [24]But as party polarization has continued to grow over the years, environmental concerns have become a liberal and Democratic topic. However, the past demonstrates that the people and politicians have the capability of finding common ground on big issues. Even today, when party polarization is at an all-time high, Americans have more in common with each other than they might think. The essay, “The Ideological Right vs. the Group Benefits Left,” describes how the Republican Party is based on big, ideological issues, while the Democratic Party is based on specific policy issues. While people typically align themselves as strongly Republican or strongly Democratic, public opinion polls have shown that most Americans are “decidedly pro-conservative when asked general questions but lean left on specific policy items,” regardless of which party they identify with. [25]These findings reveal that compromise, unity, and a drive for the common good are possible—if we can eliminate party polarization.

The solution to party polarization is a Twenty-eighth Amendment to the Constitution instituting proportional representation in the House of Representatives. Under this amendment, congressional districts would be represented by more than one politician, and when election time came around, voters would simply vote by choosing the political party they felt most closely resembled their ideology. Under this system, individual votes would matter more and people would be more accurately represented in the government. This would help to eliminate party polarization by allowing more than one political party to have power at a time. More voices would be heard, instead of only the voice of the majority, and because there would be multiple parties, it would be more difficult to divide issues along a partisan line. Proportional representation would encourage more compromise on policies and would allow Congress to take on larger, more pressing issues. A Vox article titled “This Voting Reform Solves 2 of America’s Biggest Political Problems” supports the idea of proportional representation by affirming that it would move American politics “toward compromise and coordination that would solve pressing public problems.” [26]

It’s worth noting that proportional representation could only be used to solve political division in the House of Representatives because of the way that it currently functions, with 435 members who are elected all at once, every two years. The Senate on the other hand, with only 100 members who are elected in staggered elections every six years, would not bode well under a proportional representation system without massive reform.

The solution for the healthcare crisis our country is currently facing, as well as countless other issues, would be solved if the United States were to implement proportional representation under a Twenty-eighth Amendment. With the empowerment of more than two political parties, politicians would finally begin to seek compromise and solutions to the issues faced by our country, instead of merely trying to enforce party agendas.

Amelia Ard is a Running Start student at Columbia Basin College.

[1] Dan Balz, "Crisis exposes how America has hollowed out its government," Washington Post, May 16, 2020,  https://www.washingtonpost.com/graphics/2020/politics/government-hollowed-out-weaknesses/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening

[2] Jessica Glenza, “Up to 43m Americans Could Lose Health Insurance Amid Pandemic, Report Says,” The Guardian, May 10, 2020, https://www.theguardian.com/us-news/2020/may/10/us-health-insurance-layoffs-coronavirus

[3] Selena Simmons-Duffin, “Millions of Americans have lost Health Insurance as Unemployment Soars,” NPR, May 13, 2020, https://www.npr.org/2020/05/13/855096156/millions-of-americans-have-lost-health-insurance-as-unemployment-soars

[4] Glenza, “Up to 43m Americans.”

[5] Abbe R. Gluck and Timothy Stoltzfus Jost, “COVID-19 Means People are Losing their Health Insurance just when they may get Sick,” The Washington Post, April 13, 2020, https://www.washingtonpost.com/outlook/2020/04/13/covid-19-jobs-health-insurance/

[6] Gluck and Jost, “COVID-19 Means People”

[7] “Who are the Remaining Uninsured, and why do they lack Coverage?,” The Commonwealth Fund, August 29, 2019, https://www.commonwealthfund.org/publications/issue-briefs/2019/aug/who-are-remaining-uninsured-and-why-do-they-lack-coverage

[8] “Underinsured Rate Rose from 2014-2018, with Greatest Growth Among People in Employer Health Plans,” The Commonwealth Fund, February 7, 2019, https://www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health

[9] Dan Brook, “Why We Need Medicare for All,” The Progressive, May 7, 2020, https://progressive.org/op-eds/why-we-need-medicare-for-all-brook-200507/

[10] “Health Care - Understanding Racial and Ethnic Differences in Health in Late Life,” NCBI, 2004, https://www.ncbi.nlm.nih.gov/books/NBK24693/

[11] Sherita Hill Golden, “Coronavirus in African Americans and Other People of Color,” Hopkins Medicine, April 20, 2020, https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-racial-disparities

[12] Thomas Jefferson, The Declaration of Independence, July 4, 1776, as found on Founding.com, a project of The Claremont Institute, founding.com/the-declaration

[13] Thomas Patterson, “Political Culture,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_1-V002300_DTH.mp4

[14] Bernard Crick, "The Presuppositions of Citizenship Education," Journal Of Philosophy Of Education 33, no. 3 (November 1999): 337. Academic Search Complete, EBSCOhost

[15] Thomas Patterson, “Welfare and Income Policy,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_4-V002000_DTH.mp4

[16] Balz, "Crisis Exposes”

[17] Thomas Patterson, “Political Parties,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_3-V002400_DTH.mp4

[18]James Madison (or Alexander Hamilton), “The Federalist Papers: No. 51,” first published Feb. 8, 1788, reprinted from The Avalon Project, avalon.law.yale.edu/18th_century/fed51.asp

[19] Thomas Patterson, “Congress and Party,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_2-V000500_DTH.mp4

[20] “U.S. Senate: Qualifications & Terms of Service,” United States Senate, https://www.senate.gov/senators/qualifications_termsofservice.htm#:~:text=Article%20I%2C%20section%203%20of,%2D%2Dface%20election%20or%20reelection

[21] Thomas Patterson, “Congress and Constituency,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_2-V000300_DTH.mp4

[22] Patterson, “Congress and Constituency”

[23] James Madison, “The Federalist Papers:10,” first published Nov. 23, 1787, reprinted from The Avalon Project, avalon.law.yale.edu/18th_century/fed10.asp

[24] Thomas Patterson, “Regulatory Policy,” Harvard University EdX, March 19, 2020, https://d2f1egay8yehza.cloudfront.net/HarvardXHKS101A_4-V000800_DTH.mp4

[25] Matt Grossmann and David A. Hopkins, "Ideological Republicans and Group Interest Democrats: The Asymmetry of American Party Politics," APSA 13, no. 1(2015): 1-36,  matthewg.org/papers/ideologicalright.pdf

[26] Lee Drutman, “This Voting Reform Solves 2 of America’s Biggest Political Problems,” Vox, July, 26, 2017, https://www.vox.com/the-big-idea/2017/4/26/15425492/proportional-voting-polarization-urban-rural-third-parties