The United States is never out of an election cycle – almost as soon as the 2018 midterms were over, the race for the presidency began. And a group of left-wing congresswomen elected last year – Alexandria Ocasio-Cortez and her “squad”, Ilhan Omar, Ayanna Pressley and Rashida Tlaib – will prove pivotal in the race for the Democratic nomination. A few weeks before I arrived in New York in mid-November, all endorsed Bernie Sanders for the nomination bar Pressley, who supports Elizabeth Warren. The endorsement appears to have shifted some momentum towards Bernie Sanders, while the gaffe-prone Joe Biden is trending downwards in many polls. Sanders now seems to be gaining support in some early primaries such as New Hampshire and Michigan. How far can he go?

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The presidential race was not the only election under way while I was in America. A swathe of local elections – for state legislatures, councils and governors – were also taking place in a country where local elections actually matter. The Democrats enjoyed a triumphant night on 4 November, winning the Virginia state legislature, which hasn’t been blue since 1994, while Andy Beshear took the Kentucky governorship. And in Seattle, it looked as though the city’s socialist council member, Kshama Sawant, would be ousted by the Amazon-backed Egan Orion (the corporation has its headquarters in the city). But despite the firm spending $1.5m on the race, the incumbent, a member of the Socialist Alternative party, retained her seat. The winners here are not old-fashioned Democrats, and the reaction to these results among the Sanders crowd was euphoric.

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One of the defining election issues, in both local and national contests, is health care. Warren and Sanders are both promising “Medicare for All” policies, which would replace private insurance with a tax-funded public model. It’s not hard to see why – you can’t really go anywhere without witnessing the impact privatised health care has had on American society. When wandering out of a Starbucks I stopped to chat to a homeless man on the street. He told me he was born blind in one eye – he didn’t have health insurance so he couldn’t receive the ongoing treatment that such a condition would require. Instead, he worked at a local logistics company. He gestured to the other side of the road, “right there, that’s where I went blind”. Unable to access public health, and without social or community networks to rely on, he ended up on the street.

Health care isn’t just an issue for the poor. On the flight home, I sat next to a British man who’d recently moved to the US. He told me a friend of his injured himself while at the gym and required emergency care. Though their company provides them with health insurance, that doesn’t include so-called co-pays – the excess you have to pay under almost any insurance plan. His 15-minute trip to the hospital ended up costing his friend $3,500: “Lucky for him, that’s his entire excess gone – he can hurt himself as much as he wants now and it won’t cost him a thing.” It struck me that the idea of “hurting oneself as much as one likes” is a peculiarly American concept.

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The conversation about the “billionaire class” that has recently emerged in the UK has been taking place over the Atlantic for several years now. One of Alexandria Ocasio-Cortez’s staffers, Dan Riffle, went viral with the line “every billionaire is a policy failure”, which is now something of a rallying cry on the US left. Just a few days after the Labour MP Lloyd Russell-Moyle stated that he didn’t believe billionaires should exist, Bill Gates made the headlines for criticising Warren’s plans to tax billionaires at a rate of 6 per cent. Gates said, jokingly: “If I had to pay $20bn, it’s fine. But when you say I should pay $100bn, then I’m starting to do a little math about what I have left over.”

Many younger voters pointed out that the answer to Bill Gates’s maths question was around $6bn – if you taxed the Microsoft co-founder $100bn, he’d still be a multi-billionaire. A vivid illustration of the scale of Gates’s wealth went viral on the social media app TikTok. A young woman uploaded a video of herself using the website “spend Bill Gates’s money” and discovered that Gates could buy every team in the NFL and still have $16bn left over.

The responses of Warren and Sanders spoke volumes about their respective campaigns. Warren reassured Gates that she wouldn’t cost him $100bn, and that she’d be happy to meet him to explain her tax plans in person. Sanders, chiming with his millennial audience, tweeted: “Say Bill Gates was actually taxed $100 billion. We could end homelessness and provide safe drinking water to everyone in this country.” He has a point. Last year in the US, billionaires paid less as a proportion of their income in tax than the average working family.

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I spoke to a group of policymakers, politicians and their staffers at the Aspen Institute, a think tank that leans towards the “Clintonite” wing of US politics. Most of them were not the enthusiastic converts to socialism whom I addressed during the rest of my tour. But when I opened my discussion about the problems with American capitalism by pointing to a recent Financial Times front page – “Capitalism: time for a reset” – there were murmurs of recognition. However you look at it – Amazon backing council candidates, working families unable to access health care, the growth of the billionaire class – it’s hard to shake the feeling that US capitalism isn’t what it used to be. The question the US faces in 2020 is “can it be revived, or should it be replaced?”

Grace Blakeley’s “Stolen: How to Save The World From Financialisation” is published by Repeater Books