The debate over the future of healthcare has been at the forefront of American domestic policy for over 70 years. It was the number one issue among Democratic voters in 2019 and has been on the top 5 list for decades. Nearly 30 million U.S. citizens do not have health insurance and over 40 million find themselves underinsured. 18% of U.S. GDP is spent on health care, at $3.5 trillion dollars (with $10,739 per person). Two-thirds of people who file for bankruptcy do so because of medical bills. And out of the 33 developed nations of the world, the United States is the only one that does not provide universal health care for its citizens.

The Center for Medicare and Medicaid Services projects that by 2027, the U.S. will be spending nearly $6 trillion on health care. American health care costs soar above what other developed countries spend on their healthcare. Canada only spent $253.5 billion in 2018, the U.K. budgeted £139.3 billion (approximately $172 billion) for 2019, and Japan spent ¥42.2 trillion (approximately $395 billion) in 2017. Americans spend more on medical bills than any other citizenry. The market system is not covering all citizens as well as the universal plans do in other developed countries, and the cost will rise over the coming years. The system as it stands now is unsustainable and requires reform  —  if health care isn’t your top issue for 2020, I hope these numbers convince you to put it in your top five.

We know it is possible to cover every person and to reduce the cost because other developed nations are spending a fraction of what we do per year and per capita. Three universal health models have worked for multiple countries. In the Beveridge model (used in the U.K. and Scandinavia) the government owns and contracts hospitals and acts as the single-payer — citizens support it through taxation and never receive a bill. The Bismarck model, a multi-payer system in practice in Germany and Japan, has employers and employees collectively fund “sickness funds” that effectively acts as insurance. The government heavily regulates these organizations and ensures that every citizen is covered. And in the National Health Insurance Model, the government contracts private sector hospitals and doctors as the single-payer — a sort of marriage between the two prior models.

Universal health care is not necessarily single-payer — as demonstrated by the Bismarck model — but single-payer is the most simple, efficient and cost-effective model for a country’s health cost. If you are a reader who believes that the idea of single-payer health care is socialism and that government has no business interfering with the for-profit insurance market, then I encourage you to skip the rest of the article and to leave your nasty comment  — this article is for people who are willing to vote for change. But before you head off, I just want to remind you that in your world 70% of Americans (including 52% of Republicans), as well as 56% of our doctors, already seem to be down with socialism through Medicare for All.

While a Bismarck model might work for Germany, the issue with American health care isn’t that insurance costs too much money — although paying a middle man sure doesn’t help poor and middle-class Americans — it’s that the medicine and healthcare cost so much to begin with. Real change means having a position at the table with hospitals, manufacturers and pharmaceutical companies for reasonable price caps. Insurance companies make individual deals with these players in the current system, and it is up to your employer to decide what plan you get .

Moderate Democratic presidential candidates like former Vice President Joe Biden and Mayor Pete Buttigieg propose an expansion of the Affordable Care Act, where the government would provide a public option to insurance. It seems like a win-win for the current system – anybody who doesn’t have access to insurance through their employer can acquire it through the public option, and those who already have plans with a provider can choose to keep it. It’s the free market but with a public service — no need for the socialist abolishment of an industry. Does that not suffice? The answer is, of course, no. If we agree that the goal is universal health care, then we believe that nobody should be denied a medical service because they can’t afford it. Maintaining a for-profit market is antithetical to this idea.

For a market to exist, the product can’t be given to everybody. The public option will still require people to pay a bill when they go in for medical services. Whether that’s through buying in, co-pays or premiums, the public option keeps society’s most vulnerable at risk of steep costs. A public option is incredibly advantageous to private providers. Insurance only works if few people use it compared to the amount of people who buy into it. Insurance companies will minimize risks if they can, some denying perfectly eligible applicants because they had a pre-existing condition before the ACA passed.

If a public option is available to people who need it and it is actively competing against the private providers, all private insurance companies have to do is drop their high-risk clients to the public option and service those who use their insurance less. The more people who buy into the public option, the more it will be used. This causes failure, like the ACA after the mandate failed to take hold and premiums went up despite the political promise that prices would stay the same.

A single-payer option means that we all pay for it because we all use it. The question for those who oppose the idea is what becomes of the private insurance industry once we adopt single-payer? Do we just lose an industry? Do those jobs just disappear? Private insurance can still exist in a single-payer system, it just can’t compete with it. Private insurance needs to be supplemental to the system. But there is, of course, the risk that we lose the private insurance industry, and if that were to be the case, then the people who worked at those providers would be the most qualified people to work in the expanded system.

If you would like to vote for someone who intends to fix the issue, you probably won’t vote Republican. Their last attack on health care was projected to leave 23 million more people uninsured than the current law. Universal health care is the moral, affordable and fiscally conservative direction to go, and we need to make sure that 2020 is about health care. If it’s not your number one issue, then it should be close. It is depressing that only one presidential candidate has an actual proposal for it — Senator Bernie Sanders’ Medicare for All. Universal care is not necessarily Medicare for All, nor does it have to be. The rest of the world has shown that there are so many ways to approach the problem, and every solution in the direction of health care for all is better than what we have now. What matters is that we demand reform and change, that we don’t have to be an outlier on the human right to health care in the developed world. Support candidates that will fight for our right to live — without having to be wrung dry of our wealth.

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@gavingitsgud