Trump's Fantasy about COVID-19 Keeps Killing Americans. What Can Be Done?

By JOHN GEYMAN, M.D.

We have seen the worst of fantasyland under the Trump administration that now renders our country hostage to the tight grip of the worst global pandemic in 100 years. Trump and his corrupt administration are still trying to hold us hostage to his dangerous ideas as he attempts to hold power for another four years by his conspiracy theories of election fraud and his refusal to concede that he lost the election. His policies have already dismantled many of our institutions to the point that a new Biden administration will have an unusual challenge digging out from under the rubble.

Soon after his inaugural, Trump disbanded the White House agency charged with pandemic planning. It went downhill from then on. Trump and his administration were largely missing in action dealing with the triple crises simultaneously confronting the country—COVID-19, the economic downturn, and protests against systemic racism. From the start, Trump showed an appalling level of denial, ignorance, incompetence, and lack of caring.

As the pandemic worsened, Trump denied responsibility himself, shifted responsibility to the states, then blamed them for their responses as they fought among themselves to acquire critically needed supplies of test kits, protective clothing, ventilators and other urgent needs. He turned to son-in-law Jared Kushner to manage the Strategic National Stockpile, but shortages persisted, prices skyrocketed, and there was no effective system for distribution. Trump failed to declare a national emergency or to invoke the Defense Production Act.

By June, the economic downturn was severe across all 50 states with many businesses closed and employees furloughed or let go. More than 40 million Americans had filed for unemployment insurance for the first time, with many of those jobs not coming back. The unemployment rate was the highest since the Great Depression. Almost 27 million Americans had lost their employer-sponsored health insurance, and could not afford to seek essential care. The US economic output fell at a 32.9% annual rate in the second quarter, the largest drop since government records were begun in 1947.

As the COVID-19 pandemic continued its spread across the country, our long-standing disparities and inequities became apparent. Although being just 12.5% of the US population, African-Americans have accounted for 23% of all COVID-19 deaths. Compared to whites, minorities are more likely to be uninsured, to have higher unemployment rates, and to be less able to work from home while sheltering in place.

In the weeks leading up to the November elections, Trump continued to defy public health guidelines by refusing to wear a face mask and holding campaign rallies in large congregate groups, some even in closed indoor spaces.

The White House itself became a super spreader as he and some of his close advisors became infected with the coronavirus. Meanwhile, in defiance of CDC guidelines, he has kept on pushing for early reopening of the economy and schools while the pandemic is still out of control.

We are facing a long, hard winter before the incoming Biden administration can start to bring it under control. The University of Washington’s Institute for Health Metrics and Evaluation has projected that COVID-19 deaths will exceed 400,000 by the end of 2020.

National polls show 68% of Americans believe that the country is on the wrong track but Trump’s base remains in the 40% range of support. Since the pandemic makes polling places a hazard to voters’ health, the emphasis moved to mail-in ballots. However, Trump’s assault on the US Post Office, together with GOP efforts to suppress voting in many states, raised questions whether democracy could survive the November election. Trump’s allegations of election fraud, however, have not been confirmed anywhere and democracy has prevailed.

The Biden-Harris team achieved a 6.8-million-vote win in the popular vote and a 306-232 majority in the electoral college. A majority of US citizens have voted out the most corrupt and dangerous administration in our history. While the margins have narrowed in Congress, we can hope that the Georgia runoffs for two Senate seats will result in equal Senate seats for Democrats and Republicans. In that event, a 50-50 tie can be broken by vice president Harris’s 51st vote.

What, then, are some of the most urgent directions confronting the new administration and Congress as they begin to move toward a ‘new normal’ beyond the pandemic and economic downturn? With overall goals to restore a science and fact-based approach to governing, bring the COVID-19 pandemic under control, and rebuild public health and our health care system, these are some of the most urgent directions that can address these goals:

1) Rebuild public health, including increased long-term funding of the CDC, state and local public health departments.

2) Provide universal coverage to health care by enacting a new system of national health insurance through single-payer Medicare for All.

3) Stabilize hospitals and other facilities, with an emphasis on serving underserved and rural areas.

4) Expand primary care with an emphasis on smaller, community-based independent practices, not corporate Walmart clinics.

5) Set up an improved capacity for physician workforce planning, with the goal to address the increasing primary care shortage.

6) Establish a solid federal and state-based health planning system to prepare for future needs, including pandemic preparation.

The Expanded and Improved Medicare for All bill currently in the House (HR 1384), with the support of 130 Representatives as well as an additional 30 members of the Senate, can lead the way toward these goals. It would provide coverage for health care based on medical need, not ability to pay, through a new not-for-profit national health insurance program (NHI). Cost sharing at the point of care, such as copays and deductibles, would be eliminated, as would the current private multi-payer financing system. Large savings would be achieved through administrative simplification, bulk purchasing of drugs and medical devices, global budgets for hospitals and other facilities, and no longer having to pay the exorbitant administrative and marketing costs of private health insurers. These savings, together with progressive taxes whereby 95% of Americans would pay less than they do now for health care and insurance, would cover the costs of bringing universal coverage to all Americans.

Employers will benefit since the pandemic has proven the inadequacy of employer-sponsored health insurance (ESI), by far the largest segment of private health insurance. Before the pandemic, it was already unacceptably volatile and unreliable in view of realities of employment in this country—66 million people lost their jobs in 2018, thereby losing insurance unless fortunate enough to get another job with insurance; benefits under ESI keep being reduced as employers limit benefits and as employees pay more in lost wages; and small business (88% of US businesses) usually cannot afford to provide insurance.

There are other advantages that will accrue when Medicare for All is enacted that will help our nation confront the pandemic and its resultant recession/depression:

1) The 13-plus million confirmed COVID-19 cases will receive necessary care.

2) The labor market and economy will be helped by allowing employers to redirect money they have been spending on ESI to their employees’ wages.

3) The poverty level can be reduced by more than 20 percent by eliminating cost sharing, self-payments, and other out-of-pocket costs of health care.

Gerald Friedman, Ph.D, professor of economics at the University of Massachusetts Amherst has done ongoing studies of the costs of single-payer NHI for the last 10 years. He tells us that we would have saved more than $1 trillion in 2019 had it been in place then. As shown in his 2020 book, “The Case for Medicare for All,” big savings would have occurred in three areas of health care spending:

1) Reduction to Medicare negotiated rates (bulk purchasing and negotiated prices for hospitals, drug companies and medical device manufacturers)— $649 billion

2) Insurance administration (interaction with multi-payer insurers)—$258 billion; and

3) Provider administration (the billing process)—$192 billion.

Faced with our triple crises, the need for competent and responsive government has never been greater. The big question before us now is whether we can get past the widespread polarization of our society and politics, and pull together to address the common good. Last April, the Editorial Board of the Financial Times summarized the challenge, very relevant today, as the COVID-19 pandemic gained momentum:

“Beyond defeating the disease, the great test all countries will soon face is whether current feelings of common purpose will shape society after the crisis.”

John Geyman, MD, is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, Wash.

From The Progressive Populist, January 1-15, 2021

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