3.5 Trillion Reasons

No country can be strong whose people are weak and poor

                                      ~ Theodore Roosevelt

In 2018, it is estimated that 18% of GDP would represent an industry with an impact of 3.5 trillion dollars, and yet Americans are going without healthcare, expenditures are rising, and more than 70% of the electorate now prefers the idea of single-payer healthcare. The Tfight in front of the United States will be epic. There are about 3.5 trillion reasons why. 

The United States of America leads all other wealthy countries in expenditures per person.

As the 20th century dawned, the United States had yet to form a health care system, there were no retirement benefits, no social security, the young nation was just being able to forget a bloody civil war, the west had been opened, and the young nation was gathering steam as an economic power. As the United States came of age; healthcare became an ongoing topic of political discourse. Americans moved away from their farms and headed toward the big city. The era of doctors making housecalls in a horse-drawn buggy were at an end.

As the twentieth century moved out of the WWI era, the cost of healthcare had already skyrocketed beyond the affordability of most Americans, this led to President Franklin Delano Roosevelt (FDR) trying to establish a Medicare for all program and the creation of old age pensions. Political compromise saw the healthcare provisions removed while Social Security was established. It was a political tradeoff.

Harry Truman tried to revive FDR’s health care plan, amplifying it to allow for coverage for everyone. The opposition howled that it was right out of the communist playbook. Truman abandoned the plan as the Korean War broke out, but years later he saw Medicare come to exist as President Lyndon B. Johnson (LBJ) signed Medicare into existence in a ceremony he conspicuously decided to hold at the Truman Presidential Library. It was a nod to the efforts of President Truman for his efforts to find a way to provide more healthcare to the American people.

In 1960 the federal government began to track national healthcare expenditures (NHE), this is when we started linking it to the nation's gross domestic product (GDP) and it started tracking at 5% of GDP; today it’s over 18%. 

President John F. Kennedy (JFK) tried for universal coverage, but instead of through the normal channels, JFK went directly to the American people. The American Medical Association (AMA) opposition was harsh, well funded, and very strong. The AMA lobbying efforts dragged the fight out. It was a fight JFK would not be able to finish. LBJ was a gifted legislator and used the legacy of JFK to expand coverage through Social Security for seniors and disabled citizens, ushering in the Social Security Act of 1965, crafting the foundation of Medicare and Medicaid.

Senator Edward "Ted" Kennedy, in the 1970s, proposed single payer healthcare similar to Canada, but President Nixon wanted corporations to provide healthcare instead. The thinking was that working-age citizens would have healthcare from their employers and seniors would get healthcare from the government. Kennedy and Nixon were able to work together across the aisle before Watergate erupted, HMO’s were created and social security was expanded. As Reagan came to power, the US was spending nearly 9% of GDP on healthcare. The Reagan White House facilitated the removal of numerous regulations while creating COBRA, a benefit still available today.

By the time Clinton was president, the NHE had passed 12% of GDP. The Clinton administration had strong hopes for a state-based cooperative. The Clinton plan enshrined the concept of not allowing pre-existing conditions to be considered. Corporations would be required to supply healthcare for all full-time employees. The Clinton administration was unable to attain their goals regarding healthcare, but Clinton did usher in CHIP and Medicaid for uninsured children. George Bush started when NHE was at 13.3% of GDP, and he facilitated Medicare Part D. Every President that tried to move America towards single payer healthcare met unsurmountable resistance on a number of levels. But each did leave a legacy that helped more American citizens get healthcare.


The attacks on 9/11 and the second Iraq war elbowed the health care debate to the sidelines. When the PPACA a.k.a. Obamacare was devised, the NHE was eclipsing 17% of GDP (17.4%). Almost ten years later, the rate of growth of healthcare expenditures has finally slowed but it still checks in at an estimated 18.2% (estimated for 2018).

Now, in 2019, after narrowly escaping the full repeal of Obamacare during the first half of the Trump administration and coming within a mere vote of seeing tens of millions of Americans lose their health care, the debate continues to rage. Only now the tide has turned. Democratic candidates beginning the process of lining up to run for President of the United States in 2020 are making single payer healthcare a debate that is front and center. 

The healthcare debate in the United States has been laden with drama during the Trump Administration. While data shows the rate of expenditure growth is starting to slow at the same time more Americans are getting coverage, nobody is talking about the data points. Healthcare has, and always will be, one of those wedge issues that can make or break a Presidential campaign. When over 70% of Americans want single-payer healthcare, you can be sure we will hear a lot about during this campaign cycle.