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I was told Bernie Sanders would be unlikely to enact it should he become president, but I don't understand why exactly. Particularly, I don't understand the intricacies of American politics.

I would like someone to lay it out and basically tell me what obstacles a president would face why trying to enact Healthcare For All (as proposed by Bernie Sanders, other candidates have their own plans).

I am not asking why it's being opposed by some people at all. For some reason, someone tagged this as a duplicate when the question has nothing to do with that.

Sayaman
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    Your question was quite opinion-based and needlessly centred on candidate Sanders. I tried to make it a bit more general and less POB. I hope the question in its current form is still what you're looking for and yields more objective answers. – JJJ May 31 '19 at 00:35
  • The question is otherwise fine, right? The question is about the obstacles due to the political processes and government intricacies that would make the law difficult to pass. – Sayaman May 31 '19 at 00:36
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    I'd say so. Answers can be based on resistance faced by those trying to and proposing such healthcare plans in the US and abroad. There has been much debate about the subject for a long period of time so it's certainly answerable. – JJJ May 31 '19 at 00:41
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    Enacting it is possible, especially if the supporting party has a majority in both houses - see the Affordable Care Act. Keeping it is another matter, as the opposing party can dismantle it as soon as they gain a majority - again, see the Affordable Care Act. US politics is a dumpster fire, with both parties seeking to dismantle each others legacies as soon as they reasonably can. –  May 31 '19 at 00:52
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    Possibly the large number of people who would object to such a plan? It would have to be paid for with a substantial tax increase (or by major spending cuts to other programs, that have their own supporters), and not many people favor those. – jamesqf May 31 '19 at 04:58
  • Corporate lobby. Pharmaceutical, health insurance company and private hospital that profit from ARPP (Average Revenue per patient) are not going to be happy with it. Passing the law and funding is actually a small matter. – mootmoot May 31 '19 at 07:23
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    Possible duplicate of Why do people in the United States seem so averse to a Public Health system? – Steve Melnikoff May 31 '19 at 10:30
  • @SteveMelnikoff I'm not sure if they're exact duplicates. There may be more reasons than just public opinion. For example, companies and big pharma may have influence on the matter. – JJJ Jun 05 '19 at 03:52

1 Answers1

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To get such a law passed would require:

  1. Majorities in favour of the law in both the House of Representatives and the Senate. And since there are filibuster and cloture rules in the Senate, a super-majority of 60 may be required in the Senate. As only 1/3 of the Senate is elected at any one time, the chances of there being 60 senators in favour of such an act seems very remote.

  2. A Supreme Court that finds the act constitutional. Unlike other systems, in which it is assumed that the government can pass any law it chooses, in the USA the powers of the Federal government are delimited. It is not unusual for the court to say that a law is unconstitutional and void. There is currently a 5-4 Republican majority in the Court, and the president can't easily change it.

  3. A population that finds this model of healthcare so good (despite higher taxation, or less money spent elsewhere) that a future president can't repeal or replace the act.

The US system was designed to work on consensus, with the House representing the will of the People, the Senate representing the various states, and the President, above politics, carrying out the instructions of those bodies. This makes it difficult for a political president to act, especially when there is no consensus.

In the case of healthcare, this has become one of the major policy differences between the parties. Unlike in (say) the UK, where all parties of both the right and left generally agree that the state has a major role to play in providing healthcare, in the US this is very strongly opposed by one of the major parties. When an issue becomes a polarising issue, it is very hard to find the consensus that the US system requires.

Healthcare is exceedingly expensive, especially in the USA. Private insurers charge more than state insurers. People with private insurance can get healthcare that would not be available on a state-managed and rationed healthcare system. There are therefore powerful vested interests in maintaining the status quo.

James K
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  • These are the obstacles which face turning any controversial policy into law. Could you add details of why this particular policy is likely to be opposed? – Steve Melnikoff May 31 '19 at 09:23
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    "...and the President, above politics, carrying out the instructions of those bodies" - Very idealistic, and whether or not it was intended that way, I'm not sure it's ever actually happened, from the very first. – Geobits May 31 '19 at 12:17