The healthcare debate has reached a 'fever pitch,' and it's now up to the Supreme Court and the election to decide America's fate

• Paul Constant is a writer at Civic Ventures, a cofounder of the Seattle Review of Books, and a frequent cohost of the "Pitchfork Economics" podcast with Nick Hanauer and David Goldstein.
• In the latest episode of "Pitchfork Economics," Abdul El-Sayed, a leading healthcare expert, talks about how the future of healthcare is at stake.
• During the pandemic, many people lost their jobs — and their healthcare.
• On top of all that, we don't know what the long-term effects of COVID-19 will be, and if private insurers will discriminate based on it as a preexisting condition.
• He said that everything depends on the Supreme Court.

Last week, in response to my column about the outsized power employers have over their workers, a Twitter user named Jim Drinkwine pointed out a glaring omission. To my comment that underpaid workers can't simply quit and find a better job, Drinkwine added: "Don't forget if they quit, they lose health coverage."

That's absolutely correct. In fact, health insurance might be the most crucial leverage that American employers hold over their workers. As the only industrialized nation that does not offer some form of government health insurance for all its citizens, the United States places its workers in the uncomfortable position of depending on employers to provide healthcare.

The failings of this system revealed themselves in gory detail earlier this year, as millions of workers were laid off from their employers at the beginning of a global pandemic — cutting them off from health insurance right when many needed it the most. And even the most basic protections provided by the Affordable Care Act are in danger of being wiped out this fall, as the Supreme Court is set to hear arguments against the popular program exactly one week after Election Day.

We're all flesh and blood.

When a nation's health insurance is in doubt, virtually everything else is in question as well. If the Supreme Court strips away the Affordable Care Act's protections for people with preexisting conditions, will the tens of millions of Americans with health issues be able to afford coverage? If workers are afraid to switch jobs for fear of losing coverage, will their wages decline as they lose the ability to negotiate in the marketplace?

At this moment in American history, everything — from the definition of work to the security of the economy to the nation's standing in the global community — feels up in the air.

In this week's episode of Pitchfork Economics, Nick Hanauer and David Goldstein interview Abdul El-Sayed, who has risen to prominence in progressive circles for his expertise in the medical and public health fields.

El-Sayed has written extensively about the American health care system in his books — "Medicare for All: A Citizen's Guide" will be out early next year — and on his podcast, America Dissected. El-Sayed, an early and passionate supporter of Bernie Sanders's presidential campaign, recently accepted a position on the Biden-Sanders Unity Task Force, which was assigned to establish healthcare policies that the entire Democratic Party — from the far left to the center — could support.

As we approach the final 40 days of the 2020 election, El-Sayed wants voters to understand exactly what's on the ballot. "There is just a huge political fight ahead of us," he said. "It really is a scary time."

El-Sayed is one of the leading healthcare experts in America today. How does he let voters know that the future of healthcare is at stake?

"As a former health director, I'm often reminded that numbers don't do as good a job in explaining what's at stake as the stories of people's lives," he said. When we talk about the 20 million Americans who have no health insurance, "we have to remember every one of those people is somebody with a particular set of precarious circumstances, who has joys and fears, and people who love them and people they love."

This matters, El-Sayed said, because "we can't forget that those are 20 million different stories of folks who could very well be failed by our government" if the American healthcare system continues down the path it's been on for the last four years.

If that sounds like typical election-year hyperbole, El-Sayed would like to remind you that we're in the middle of a once-in-a-century pandemic.

"We don't know what the long-term consequences of COVID-19 are going to be," he said. "This disease has only really been in humans now for about nine months, and we don't know what the implications are."

So little is known about coronavirus and its long-term effects on the human body, he said, that "you can imagine a moment where even people who had asymptomatic COVID-19 are experiencing complications of that infection three, 10, 20 years on."

If private health insurance providers are allowed to discriminate against people with preexisting conditions, that means some portion of the over seven million Americans who have already contracted coronavirus could be "barred from being able to get healthcare" through the actions of the same political party that failed to protect them from an out-of-control pandemic.

El-Sayed said that our healthcare affects every aspect of our lives — even the economics of it: "Who gets access to a good job that pays a living wage? Who's allowed to stay home and work from behind the computer screen? Who has to go to work in the midst of a global pandemic?" If you work in a low-wage "essential" job that puts you on public transit every day, you could be putting your future at risk in a way that white-collar workers do not.

So what can El-Sayed share from his experience on the Biden-Sanders Unity Task Force for healthcare?

What's the plan? Everything depends on the Supreme Court, he said.

"Assuming that the ACA stays in place, which I think is a very tenuous assumption, the plan was to create a far more muscular version of a public option than [Biden] initially ran on in the primary," El-Sayed said.

Like most Sanders supporters, El-Sayed is a big believer in a Medicare for All plan that would put every American in one government-run health insurance system — a policy which Biden ran against in the Democratic primary.

But the policy that the Sanders and Biden teams agreed upon, while not as sweeping, is still robust, progressive, and offers the possibility to change healthcare in America forever.

"It's fully funded and subsidized for folks earning less than $52,000 a year for a family of four — 200% of poverty," he said.

But it's not just a safety net. The task force plan, El-Sayed said, "would be truly a public option, meaning rather than buying private health insurance for their employees, corporations could decide to enroll them on the public option."

That kind of stability would change healthcare as we know it in America, giving workers more control over their health while also likely shrinking one of the biggest costs for full-time employers.

Even big health insurance corporations would benefit from the proposed Biden plan by allowing "Medicare to negotiate the price of prescription drugs on behalf of every single American — which of course is illegal right now, because of pharma lobbying," El-Sayed said.

With Supreme Court Justice Ruth Bader Ginsburg's death, and Republican rushing to seat a conservative justice before the election, El-Sayed said the healthcare battle has reached a fever pitch.

"This is a fight that I think starts with healthcare, but could go a long, long way beyond it," he said, citing Roe Vs. Wade, and the very idea of what role government can and should play in our lives.

"There's a lot we need to be fighting for."