I don’t think there is any reasonable chance that the United States will adopt any kind of universal healthcare or Medicare for All system at the federal level any time within the next forty years at the very least. I’m currently twenty-one years old and I frankly don’t think there’s a strong likelihood that the United States will adopt any kind of Medicare for All system at the federal level within my lifetime.
Everything about the United States government is designed to give disproportionate power to conservatives. In order to implement Medicare for All, Democrats who support it would have to have the majority in both the House and the Senate and there would have to be a progressive Democratic president in office to approve it and there would have to be a liberal majority on the Supreme Court to prevent the court from striking it down.
Right now, Republican politicians are universally opposed to Medicare for All and even many moderate and conservative Democrats are opposed to it as well. There is an election coming up in November, but there is still a very strong likelihood that Republicans will retain control of the Senate. Even if Democrats do take back the Senate in this coming election, it will only be by an extremely tiny margin—probably only by one or two Senators at the very most.
Conservative Democrats like Joe Manchin will certainly not be willing to vote in favor of Medicare for All, meaning that, even if Democrats successfully take control of the Senate and abolish the filibuster, there’s probably no realistic chance of the Senate approving Medicare for All. Moreover, Joe Biden, the Democratic nominee for president, does not support Medicare for All either, so, even if Medicare for All did somehow make it through the Senate, Biden would probably veto it.
The Constitution is designed in a way that automatically gives Republicans a massive advantage in the Senate, meaning we can expect that Democrats will only occasionally manage to take control; the vast majority of the time, Republicans will have control of the Senate. If Democrats do take control of the Senate this year, they will almost certainly lose control in the next election. Once they lose control, they probably won’t regain control for another decade or so.
ABOVE: Photograph of Joe Manchin, a conservative Democratic Senator who would almost certainly vote against Medicare for All, even if Democrats controlled the Senate and there was a Democratic president
Then there’s the problem of the Supreme Court. Amy Coney Barrett will soon be confirmed by the Republican-controlled Senate to fill Ruth Bader Ginsberg’s former seat on the Supreme Court. This will give conservatives a six-to-three majority on the Supreme Court for the foreseeable future.
Right after the November election, the Supreme Court is set to hear a case being pushed by the Trump administration to overturn the Affordable Care Act (i.e., “Obamacare”). The Supreme Court upheld the constitutionality of the Affordable Care Act in a similar previous case while Ruth Bader Ginsberg was still alive, but it was upheld by only one vote and only because Chief Justice John Roberts sided with the liberals.
While Ginsberg was still alive, it looked like this upcoming case would go the same way. Now that she is dead and she is about to be replaced by Barrett, however, this means that conservatives will have the majority on the court, even without Roberts. Furthermore, Roberts will most likely side with the conservatives this time so he will be able to write the majority opinion. It is therefore extremely likely that the Supreme Court will rule the Affordable Care Act unconstitutional—either in whole or in part—by a six-to-three margin.
ABOVE: Image of Amy Coney Barrett, who will almost certainly be Ruth Bader Ginsberg’s replacement on the Supreme Court
In other words, at this point, we will be extremely lucky if the Supreme Court leaves any part of the Affordable Care Act intact. This is how the Supreme Court will be for at least the next several decades. If anyone attempts to implement Medicare for All at the federal level, the conservative court will just rule it unconstitutional and it will go in the scrap heap.
Democrats could try to pack the Supreme Court with liberal justices, but then Republicans will just pack it again with conservative justices when they retake power. It will turn into an unending cycle of relentless court-packing and, because the system is designed so that Republicans will have control of the Senate most of the time, even in this new world of court-packing, Republicans will still have control of the Supreme Court most of the time.
Meanwhile, it would be extremely difficult—bordering on impossible—to enact Medicare for All at the state level due to the Employee Retirement Income Security Act of 1974 (ERISA), which preempts all state legislation pertaining to employer-sponsored medical benefits.
I think that Medicare for All is a good idea, but, unfortunately, it’s not going to happen anytime in the foreseeable future. Again, I think we’ll be extremely lucky if we even get to keep any part of the Affordable Care Act. If you are like me and you think our healthcare system is broken, well, then, all I can say is that you’d better get used to it.
ABOVE: Stock photo of a book with “ERISA: Employee Retirement Income Security Act” on the cover. ERISA would most likely prevent state legislatures from implementing Medicare for All at the state level.