There hasn’t been a presidential election in my politically aware life where health care has not been on the agenda. The United States spends more than twice other countries per capita yet hasn’t been able to get to universal care. Every industrialized nation except the United States has universal care at much lower cost and better health measures to show for it.

Will the policies of either presidential candidate move us towards a better healthcare system? In this article, I break down the challenges of healthcare reform, the policies of President Trump and former Vice President Biden, and discuss what is needed to get this country on a path of good health and an efficient healthcare system.

The challenge

Our healthcare system was built in bits over time, and rules put in place decades ago have significant unintended consequences. For example, during the Eisenhower administration, employers were provided a tax break for health insurance for their employees, but individuals were not provided the same benefit. This tied health insurance to employment.

As work place policies became the predominant insurance vehicle, employees were provided additional protections that did not extend to the individual market – they couldn’t be turned down for coverage based on health conditions. Over time, people highly valued their workplace coverage and insurance companies loved the easy market of working with large employers. The powerful insurance lobby killed any chance of reform in the early Clinton years, along with Clinton’s inexperience with advancing healthcare legislation.

Meanwhile, the fee-for--service healthcare system that favors specialty care exploded costs. This marginalized primary care and spent a load of money treating diseases that shouldn’t have happened in the first place. Employers had minimal power to manage these market forces, so the cost of providing health insurance rose rapidly. Concurrently, before the Affordable Care Act (ACA), people not employed by large employers or covered by Medicare had minimal protection, resulting in millions of uninsured.