Like almost everyone else, of all political persuasions, I imagine, I am furious. What and whom we are furious about or with varies, of course, with how we see the world, what we value, and whether we have a “reality-based” outlook. To a great degree our perception is affected by what we want to be true, rather than what necessarily is true, and our short-term desires rather than any long-term sense.
As a physician with a great interest in and concern for public health, I am very concerned (!!) about the horrible way that President Trump and his administration prepared for a pandemic (not at all), reacted to the first evidence of one (denial), finally moved into a response (incompetently), and have yo-yo’d (good word for them) back and forth between making tentative positive moves and stepping back. Trump’s own statements are pretty accurately parodied by a meme making the rounds with him as Captain of the RMS Titanic. But we now have a response team, headed by Ivanka and Jared, with folks like Mark Meadows, Wilbur Ross, and Steven Mnuchin, so everything should be OK. Or not. We will, as Masha Gessen tells us in the New Yorker, not know the moment when democracy dies. We can have armed rallies demanding ‘reopening of the economy’, and even calls for insurrection if he loses the election, by folks like Franklin Graham.
So far, the coronavirus does not appear to be intimidated.
Predictions for the duration of this pandemic and the way in which it will change society and human behavior in the US and around the world are both dire and probably accurate. The most distressing news has been the unsurprising degree to which it has had its greatest negative impact upon the most vulnerable: the poor, minorities, elderly, and those who cannot afford to not go to work. The most inspiring aspect has been the degree to which it has highlighted the contributions of not only heroic health care workers, but all essential workers, the majority of whom are women, especially non-white women, and are generally underpaid. Among the essential workers are NOT included CEOs, hedge fund managers, political pundits, and other mostly-male, mostly overpaid roles. Walter Scheidel gives us mixed news in his New York Times piece ‘Why the Wealthy Fear Pandemics’; back to at least the 14th century, it brings about social disruption and tends to increase the relative power of workers to demand better wages and working conditions. However, he cautions, that while “more often than not, repression failed…none of these stories had a happy ending for the masses.”
But it is not just the far-right, the GOP, and Trump who are not responding well to this crisis. The Democrats have been much better, but that’s a low bar. They still insistently miss the point that a national health program would have put us in a much better position to respond to this pandemic, and at the very least have eliminated the probably of bankruptcy for many of those receiving treatment. It almost certainly would have decreased the number of people staying away from treatment because of fear of the cost. Bernie Sanders said this throughout his entire campaign, and has just said it again in a NY Times Op-ed:
We are the richest country in the history of the world, but at a time of massive income and wealth inequality, that reality means little to half of our people who live paycheck to paycheck, the 40 million living in poverty, the 87 million who are uninsured or underinsured, and the half million who are homeless.
These ideas are absolutely as correct now as they were before he left the race. We need a national health system.
Most recently (April 18, 2020) the case is made by economists Anne Case and Angus Deaton, who continue to be amazed at the fact that ‘America can afford a world-class health system: Why don’t we have one?’. They note that
In March, Congress passed a coronavirus bill including $3.1 billion to develop and produce drugs and vaccines. The bipartisan consensus was unusual. Less unusual was the successful lobbying by pharmaceutical companies to weaken or kill provisions that addressed affordability — measures that could be used to control prices or invalidate patents for any new drugs.
The notion of price control is anathema to health care companies. It threatens their basic business model, in which the government grants them approvals and patents, pays whatever they ask, and works hand in hand with them as they deliver the worst health outcomes at the highest costs in the rich world.
And make this blunt and totally accurate statement:
The American health care industry is not good at promoting health, but it excels at taking money from all of us for its benefit. It is an engine of inequality.
It is not good at promoting health. That is a bad thing. It is good at taking money from all of us for its benefit. That is a corrupt and inefficient, as well as bad, thing. It is an agent of inequality. For most of us, that is a bad thing.
And yet it persists. And its enablers include the Democratic leadership, which resolutely continues to refrain from challenging the profits of the insurance and pharmaceutical industries. They sometimes talk about how it’s a bad thing, but then so does Trump, and sadly it seems that Trump is often more sincere. The latest proposal for spending money on protecting people by the Democratic leadership is to pay for people’s COBRA (this is where you can continue to keep your former employment-based health insurance for a time when you are laid off by paying the whole premium yourself). A good thing if you were going to lose your health insurance, for sure, especially if now, not working, you can’t afford to pay not only what YOU were paying but also your employer’s contribution. Not a bad start. But, somehow, one would hope for a better, more proactive, more comprehensive, and most important more effective solution to this crisis than just paying money to insurance companies!
The media has talked about the Democratic Party and its presumptive nominee, Joe Biden, coming a bit closer to the universal health, single-payer, Medicare for All (#Medicare4All) proposals endorsed by Sen. Sanders; a recent NY Times article tells us that ‘Biden's new proposals include expanding Medicare, government insurance for Americans over 65, to those 60 and older.’ Bold! Not! Yes, it is good that people who are 64 years old will not have to risk their lives waiting to turn 65 – that would become the province of 59 year olds! It certainly would not begin to solve the problems of the health system that are apparent to all of us, not just to Case and Deaton. It leaves the uninsured uninsured, the underinsured underinsured, the folks bankrupted by co-pays, deductibles, and surprise bills (especially those from catastrophic costs, mainly a problem for the middle-income with employer-based health insurance, per the Commonwealth Fund) bankrupt, and the insurance companies fat and happy.
It is not a solution, and the only thing audacious about it is that Biden and his campaign even dared to put it out there. We are told, by all the candidates who have dropped out, by all the liberal pundits, even by progressives, that if we want to defeat Trump and incipient fascism, we have to all come together and vote for Biden. If we do, we need to see meaningful movement to put the interests of the people ahead of those of the healthcare-industrial complex, as leaders like Alexandria Ocasio-Cortez have called for. We need to see meaningful proposals from the Democratic standard-bearer.
In fact, we need to see him. Anyone seen Biden recently?