Biden: Not Medicare for All, but leadership on COVID

The defeat of Donald Trump in the 2020 election was a wonderful thing, despite the less-good news: that the “blue wave” did not appear, that the Senate (barring two unlikely upsets in Georgia) will continue to be controlled by Mitch McConnell, that the GOP gained seats in the House, and especially that 70 million Americans voted to re-elect the worst president in American history, thus supporting racist, misogynist, anti-environment, anti-union, pro-corporate and pro-billionaire policies, and bellicose macho authoritarian bluster. The election of a Black (and Asian) woman as Vice-President is historic and great. While it is possible that Biden’s uninspiring “centrist” (read “center-right”) positions gained him votes, the division in America has never been more dramatic. Cities like, most highly featured in the days following the election, Philadelphia and Atlanta (as well as New York, Los Angeles, Chicago, etc.) went 70-80%+ for Biden, while rural counties went for Trump by the same margins.

My purpose here is not to be a political commentator, but to discuss what this might mean for health care under a Biden administration. Certainly not a supporter of any kind of single payer universal health insurance, including Medicare for All, Biden further has to contend with a (probably) Republican Senate and a newly strengthened rightist Supreme Court that even as this is being written is hearing another challenge to the ACA, President Obama’s signature domestic achievement, and the scaffold on which Biden hoped to build his own health care plan by adding a “public option”.

Assuming that, despite Senate and possible SCOTUS opposition, the ACA survives and even that the “public option” becomes law, it would be a great advance in the number of Americans who had access to decent health insurance (which, in itself, may doom its chances in those two “august” bodies!) Indeed, the arguments that many, including myself, have made for the savings that could be achieved by government single-payer program (extension of an improved Medicare to everyone) would likely be somewhat achieved by a well-designed public option, since better coverage would cost less money than it does under the private, for-profit, insurance sector. Not nearly as much as would be achieved by single-payer, but enough to have a good chance of eroding the base of those who hang on to excessively costly, poor-quality private insurance.

And yet, ”Medicare for All” continues to enjoy wide public support, certainly in those “blue” cities and counties, but also within the US as a whole, including some of the “reddest” areas. People know that their health insurance is costly and that the coverage is inadequate, and that not only their lives and health are at great risk, but so (to the extent that they have any) is their “treasure”. Democrats who supported M4A were all re-elected, while many opponents were defeated. Indeed, this illustrates the difference between those in power, members of the Senate and the House (and SCOTUS) who serve the wealthy and are mostly wealthy themselves, for whom tax cuts for their patrons and corporations (under the umbrella of the scandalous SCOTUS decision in Citizens United that declared money to be speech and corporations to be people!) are the main agenda, and their constituents. The latter have poor and costly health insurance, benefit little if at all from tax cuts, and are losing their jobs right and left as US companies push more and more money to the top. For the former, Medicare for All is a bugbear; for the latter it may be a lifeline.

The most important healthcare issue in which the election of Joe Biden is likely to make a big difference, however, is the most important healthcare issue currently facing America, and the world – the COVID-19 pandemic. This second (or maybe third) wave is breaking all kinds of records for new cases, new hospitalizations, and new deaths. In my state, Arizona, we have the highest rates since July. The nation has had well over 100,000 new cases a day recently, in some of the “reddest’ counties, with rates over 200/100,000 residents in some. The reason is that the virus does not care about what you want, and apparently what we have wanted is greater opening, an end to social isolation and not going out to restaurants and bars, not having parties and funerals and visits with our relatives. We want businesses to open, we want our jobs back, we want our personal economy (not just the stock market) to improve. We bristle at the “discomfort” of masks (like the “discomfort” of seatbelts). We want to rush, en masse, onto the football field to celebrate a huge victory for Notre Dame over Clemson (oh, wait, we did that!)

The problem, of course, is that each of those things spreads the virus, and the spread of the virus means more people will die. I have often said REOPENING=DEATH and it remains true, however much we want it not to be; there is nearly a linear relationship between the degree of reopening in any city or state and the increase in the rate of cases of “the rona”. Now, as we look toward all those college students, including those from Notre Dame, returning home for the holidays, we hold our breaths as we worry about how many of their parents and grandparents will become infected and die, putting a damper on the celebrations.

Masks and reasonable social distancing will not prevent this entirely, but will help a lot; masks really decrease transmission. Having a President who wears a mask, who encourages safer behaviors, who does not encourage total irresponsibility as has the current incumbent, is likely to make a big difference. Something has to, and certainly it needs to happen soon. Most encouraging, Biden is not only willing to, but enthusiastic about accepting science as the guiding principle of the response to the epidemic. He has already named members to his COVID “panel”. It could use some more epidemiologists, some nurses, but the intent and direction are good. The increase possibility of a vaccine, especially the recent news from Pfizer, is very encouraging. With a new administration committed to making a difference by using strategies that might actually make a difference, the trajectory of the virus might be turned around.

There are, and will continue to be, great obstacles. The most vulnerable populations will continue to be the most vulnerable – including people in prison, and those immigrants in federal detention, whose rates of infection are staggering. The Pfizer vaccine requires shipping and storing at temperatures of -80 degrees, which is very difficult in many places, particularly in less developed countries where the pandemic is raging.

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But leadership from the US President can go a long way. Whatever else we might wish from him that we are unlikely to get, we can hope that Biden will provide this.