Joe Biden is the first president whose tenure will be defined and dominated by health issues. The pandemic has exposed the flaws and vulnerabilities of the healthcare system, and any attempt to preserve the link between employment and access to healthcare is doomed to failure in a country of more than 30 million unemployed. The social and other problems created by the pandemic are not going away anytime soon, and render fundamental healthcare reform inevitable. Such reform could assume the form of either Biden’s preferred ‘public option’ or the Medicare-for-all approach favoured by Bernie Sanders and other progressives within the Democratic Party. At first sight, those approaches do not have much in common, and create questions regarding the unity of Biden’s government. However, appearances notwithstanding, Biden is closer to the progressive wing of the party than ordinarily assumed and, as Evan Osnos shows in Joe Biden: American Dreamer (2020), he is going to abandon incremental change in favour of radical reform. As Osnos mentions, Biden has in principle adopted Elizabeth Warren’s proposals for easing student debt, and also adopted a limited version of Sanders’ plan for tuition-free-college. The adoption of such reforms does not so much have to do with Biden’s personal turn to the Left, but is rather the result of the realization that in the aftermath of COVID-19 the status quo is indefensible in both practical and moral terms. As William Appleman Williams argued with regard to Abraham Lincoln, Biden’s greatest achievement would be to ‘abstract himself from himself’ in order to promote long-overdue reforms in a number of diverse policy fields.

Biden’s public option aspires to create a health insurance program run by the federal government, and was included in Barack Obama’s original conception of the Patient Protection and Affordable Care Act or Obamacare. However, what might eventually become known as Bidencare, is much more promising and far-reaching in its consequences than the Affordable Care Act ever was or intended to be. It is not by accident that industry groups created to oppose Medicare for All have also expressed reservations regarding Biden’s public option. By cutting down administrative and other costs, and representing an ever-expanding number of citizens, Biden’s plan could in the long run outcompete private insurers and provide an efficient alternative to the expansion of the marketplace. Despite not assuming the revolutionary form of Medicare for All, Biden’s plan, if realized, would arguably be the most important and far-reaching piece of social legislation since the creation of the Medicare and Medicaid programs in 1965.

Although the creation of a ‘single-payer’ system such as Canada’s or Britain’s NHS is not politically feasible, there are aspects of the Medicare-for-all approach as elaborated by Sanders that could be incorporated into Biden’s agenda. Such aspects include regulating the pharmaceutical industry, reducing the price of prescription drugs, and putting an end to ‘surprise’ medical bills. It is worth mentioning that even the Trump administration flirted with some of these ideas, but abandoned them early on because of the pressure of industry groups. With regard to COVID-19, during its first 100 days the Biden administration could develop a coordinated federal response to the pandemic and demonstrate that the virus can be defeated.  As Cornell University’s Center for Health Equity observes, in the long term the biggest challenge facing the new administration is to use the pandemic as a vehicle for achieving progress in and transforming healthcare in the United States.