August 26th, 2019

Good morning <<First Name>>,

We hope this finds you happy and well-rested after a fun-filled weekend.

While we've all been soaking up these final few days of summer, world leaders have been congregating in Biarritz, France for the G7 summit. This was the first chance for the U.K.'s new Prime Minister, Boris Johnson, to showcase his friendship with President Trump and reassure the watching world that the special relationship is going strong.

As Britain heads towards its new Brexit deadline of October 31st, and the prospect of a no-deal exit grows increasingly likely, President Trump reassured us all that Mr, Johnson is "the right man" to do the job, and promised a “very big trade deal” for Britain once it had left the bloc. Will Brexit-wearied Britain take comfort in his words? We shall see.

In this week's newsletter we're turning away from the goings-on of the G7 summit and focusing our attention instead on what U.S. voters see as the single most important issue in the lead up to the 2020 Presidential election: Healthcare Reform. It's a big topic, obviously, so we're zeroing in on Medicare-for-all, an idea that has gained some serious political momentum over the past few years.



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The Definition: Medicare For All
  • A single-payer, government-run healthcare program that would cover all U.S. citizens and lawful permanent residents, and replace all existing public and private plans (with certain exceptions).
The Issue
  • America’s healthcare system leaves a lot to be desired. At present, healthcare coverage is provided by a mixture of private health insurance and public health coverage (think Medicare and Medicaid). And while the U.S. spends roughly twice as much per capita on healthcare as other developed nations, the system is ranked 37th by the World Health Organization, and scores lowest amongst the top 11 industrialized countries in overall healthcare by The Commonwealth Fund
  • It’s a $3 trillion sector and represents an 18% share of U.S. GDP. So what’s going wrong? Why does the U.S. spend so much, for seemingly so little return when it comes to healthcare? There are a couple of factors at play here. 
  • First, high administrative costs. The fragmented health insurance market means insurers set different prices for different procedures, which requires a pretty complex processing system for dealing with the full spate of medical claims across health insurance plans, and doctors surgeries, across the country. How high are the admin fees you ask? Around double that of virtually every other high-income country (bar France).
  • Second, drug costs. The U.S. seriously outpaces all other wealthy nations when it comes to per-capita drug spending - at around $1,011, its drug spending is roughly double what say France pays.
  • Thirdly, defensive medicine. In order to avoid possible lawsuits, doctors in the U.S. will order medically unnecessary diagnostic and treatment services, just to be safe. A 2010 Gallup poll of physicians suggested that $650 billion is spent annually on this sort of ‘defensive medicine.’
  • In essence: while in other countries the government has greater oversight of the nation’s healthcare system, and so can negotiate drug prices, medical equipment, and hospital costs, in the U.S., it takes a much smaller role and so has less of an ability to negotiate prices from the different healthcare providers. The result? Higher costs. 
What the public thinks...
  • How does all of this translate into what Americans think about the U.S. healthcare system? Well, it’s complicated, and a bit confusing...
  • A recent RealClear Politics poll showed that healthcare is the top policy issue for American voters, and when asked their views on the state of the current system, the majority of respondents said it was either ‘broken’ or ‘not working,’ and thus in need of either a complete overhaul or significant reform. 
  • However, in the same poll people also said that they felt the quality of their own healthcare was ‘excellent’ (20%), ‘good’ (52%), or ‘fair’ (22%). So, while voters think the system needs to be overhauled, candidates better not leave people thinking that their own healthcare will suffer as a result. 
  • Suffice it to say, while discussion of reform is high on the agenda going into 2020 (let us not forget that the Democrats ran on healthcare reform during the 2018 midterms, and won back the House), what would comprise a popular solution to America's healthcare woes is less clear. What’s the right strategy for 2020? Let us hope that candidates are clear about the choices they are really proposing.
A recap of the current system under The Affordable Care Act
  • The Affordable Care Act (ACA), otherwise known as Obamacare, was introduced in 2010 and represented a massive overhaul of the U.S. healthcare system, as well as a vast expansion of the role of the federal government in healthcare provision. The implementation process for the bill will be ten years in total, meaning it won't be fully enacted until 2020. 
  • So what did the Act do? Primarily, it sought to reduce the number of uninsured Americans by requiring that everyone have health insurance, or else face a penalty. It introduced a number of provisions designed to expand affordable coverage to more Americans, including:
  1. Broadening eligibility for Medicaid - the government-run program that provides health insurance to low-income Americans of all ages.
  2. Providing consumer subsidies (“premium tax credits”) that reduced costs for households earning 100% - 400% of the federal poverty level. 
  3. Establishing health insurance exchanges.
  4. Prohibiting health insurers from withholding coverage due to pre-existing conditions.
  5. Allowing children to remain on their parents’ insurance plan until age 26.
  6. Requiring all individual and small group health plans to cover 10 core health benefits — including maternity care, mental health and substance use disorder services.
  • Since the introduction of the ACA, the number of uninsured adults has decreased by around 20.1 million, dropping from around 16% in 2010 to 8.8% in 2017, according to the CDC.
  • The ACA has also had a specifically beneficial impact on groups from lower socioeconomic backgrounds. A 2016 study, for example, found that in states that had expanded Medicaid under the ACA - such as, Kentucky and Arkansas - low-income groups had better self-reported health.
  • Nonetheless, the ACA has also faced certain criticism for its high deductibles and premiums, particularly for those who don't qualify for federal assistance. According to the CommonWealthFund, despite the fact that more Americans are now insured under the new system, more people are also underinsured under its provisions (aka, they report facing out of pocket costs). According to data from eHealth, for example, in the first four years of the ACA, every age group and household type experienced a premium increase of between 56.0% and 63.2%.
  • In 2016, President Trump won the election promising to repeal Obamacare and replace it with an alternative system. But, in practice, while the Trump administration has limited certain provisions, curtailed some of its programs, and recently backed a lawsuit that declared it unconstitutional, many of the ACA's elements remain largely intact. And thus, as we head into 2020, the debate around how to fix America's healthcare system rages on
So, is Medicare-for-all the answer?
  • The ACA went some way to addressing the myriad of issues plaguing the U.S. healthcare system, but for many, like Vermont Senator Bernie Sanders, it didn't go anywhere near far enough. Instead, he's proposed a government-run, single-payer system that would provide universal coverage for American citizens. That is: Medicare-for-all.
  • Although there are numerous variations of Medicare-For-All and Public Plan Proposals circulating through Congress, all focused on expanding the U.S. healthcare system and each defined by the way in which they suggest it be done (not to mention the extent of the reforms suggested), it’s Sander’s proposal that has gained the most attention. 
  • He has resubmitted the bill five times since first introducing it to Congress in 2013. And while the initial proposal had zero cosponsors, Medicare-for-All has begun to gain some serious momentum,  with the latest iteration of the bill garnering 14 co-sponsors, including four fellow 2020 candidates. 
  • So what does Sander’s version of Medicare-for-All actually entail? A few things. Here's a quick overview. 
  1. What is it? A single federal program with comprehensive healthcare benefits for all U.S. residents. There would be no role for private insurers and it would replace Medicaid, Medicare and CHIP, while permitting all Americans to see any doctor they wish without deductibles or copays. Everyone would have life-time enrollment from birth.
  2. How would it be funded? Through tax increases, income-based premiums paid by employees and employers, and a fee on large financial institutions. During the last debates in Detroit, Sanders was the only candidate to admit that his proposal would result in a tax increase for the middle classes. 
  3. What does the public think? Well, it’s a little hard to know since voters aren’t always entirely clear on what ‘Medicare-for-All’ really means. According to a recent poll by the Kaiser foundation, when voters were given full details of the health plans being discussed, 56% supported a true Medicare-for-all plan, whereas 74% said they favored a proposal that would give them the option to buy a Medicare-like plan, or keep their current coverage if they like it. 
  4. What do the other candidates think? Support for Sanders’ Medicare-for-All plan has wavered amongst the candidates. Kamala Harris notably took a major u-turn on her healthcare stance following the first debate. After raising her hand in support of eliminating the private insurance market a la Bernie, she quickly published her own healthcare plan confirming that she would actually allow private insurers to remain in the market. Her now vocal doubts about the Vermont senator’s proposals have raised some serious skepticism given that she was the bill's first cosponsor two years ago. Other candidates who have cosponsored Sanders' bill include Sens. Elizabeth Warren, Cory Booker and Kirsten Gillibrand.
  • Check out our expertly curated playlist of podcast episodes below for further insight on how Medicare-for-all fits into the U.S. healthcare debate. They're a great way to better get-to-know this fascinating topic, we promise.

A curated playlist of podcast episodes looking at Medicare-for-all.


When it comes to the failings of the U.S. healthcare system the areas worst hit are those with limited facilities to start with. Across rural America, hospital closures are on the rise, making it increasingly difficult for small towns to access healthcare. Would Medicare for All help solve this?
In this episode, NPR examines the hollowing out of America’s healthcare system and the policies intended to reverse this trend.  



Are pharmaceutical companies in the U.S. gaming the system and profiting unfairly from sick people’s misfortune? Or are the high price tags attached to so many medicines essential to the continuation of drug innovation?
Drug prices in America have been going up by nearly four times the rate of inflation over the past 12 years and, according to a recent report by the Centers for Disease Control and Prevention, nearly one-third of uninsured Americans in 2017 used their prescribed medicine differently than recommended in an attempt to save money.
In this episode, Deep Dive discusses what impact the pharmaceutical industry's monopoly power over drug pricing in the U.S. has on our access to adequate healthcare, and what reform to this system might look like.



The debate surrounding Medicare for All is front and center amongst Democratic candidates campaigning for their party’s Presidential nomination. While they all seem to agree on the concept of universal healthcare, they differ significantly on what that means. From the most extreme reform being put forward by Bernie Sanders, a single-payer system that eliminates private insurance, to the more moderate alternative, Medicare expansion, supported by the likes of Former Vice President, Joe Biden. 
In this episode, Vox’s Today Explained examines the different versions of Medicare being endorsed by the candidates; what the public thinks of these myriad proposals; and the Republican party’s counter-narrative. 


This rounds up our deep dive, but stay tuned as we will revisit this important issue in a future newsletter.

2020: The Election


Tom Steyer is the self-made billionaire and former hedge fund manager from California who recently threw his hat into the 2020 Presidential race with $100 million (at least) to self-fund his campaign. That’s more than any of the other Democratic candidates have raised thus far.
Since the 2016 election, Steyer has been a vocal opponent of the Trump administration and has funneled millions of dollars into pushing for the President's impeachment. But he's not just running on an anti-Trump agenda. A long-time environmental activist, Steyer also wants to tackle the corporate greed and political corruption from which he says so many of our climate-issues emanate. 
Still relatively lesser known amongst the wide field of candidates, he has surprised Democrats by fast amassing not only 130,000 donors, but also registering in three polls at above the 2% threshold. He just needs one more qualifying poll result before August 28th and he'll make it to the debate stage next month. 
In this podcast interview with Political Climate, we get to know the latest Presidential hopeful and hear why he thinks he's the right person for the job.


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Words by: Emma-Louise Boynton
Editing by: Jim Cowles, Stacy Perez and Emma-Louise Boynton


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