Atul Gawande makes the case for electing Joe Biden President in the New Yorker. He argues that a Biden administration will build a strong public health infrastructure to control the pandemic, which will begin the reforms necessary to fix our broken health care system. At the same time, Gawande appreciates that the Biden administration will not deliver us the guaranteed health care we so desperately need.
No question that a President Biden will make controlling the pandemic a priority. And, there’s also no question that doing it well will move us towards a better health care system. The only question is whether Biden and a Democratic Congress will do it as well as it should be done.
Vice-President Biden and House Speaker Nancy Pelosi have already made clear that they do not have any interest in automatically guaranteeing everyone access to affordable health care through Medicare for All. But, continuing our fragmented private health care system means no good real-time data of what’s happening with the pandemic and, more generally, with people’s health care. It also means premiums and out-of-pocket costs will continue to rise. There’s good reason to believe many people will skip testing and treatment because of the cost.
Without a single public health care system, the federal government will have little ability to make system improvements that will help. Just look at how poorly hospitals and insurers responded to the Congressional mandate that COVID-19 testing be free. People continue to see big bills, and as a result, many people are not getting tested or treated when they should.
If there’s good news, it’s that Vice-President Biden and a Democratic Congress will trust the science and available evidence. They will be forthright about what is happening in the country and what people need to do to protect themselves and their community. They will also appropriate and disburse at least some of the funds needed to keep the economy from sinking. And, they will offer help to people and hospitals in need. How much help they will provide businesses and individuals is still an open question.
In stark contrast, President Trump and his administration and Congress have lied to the American people about the dangers of the virus, denied the science, and done precious little to fight the virus. For example, they should have imposed a national mask mandate. Instead, their actions have led to the needless death of countless older adults, health care workers, working people and their children. They have failed to ensure adequate supplies of personal protective equipment for health care workers and other essential workers, including a disproportionate number of Americans who are Black, Latino and low-income.
The number of reported COVID-19 deaths is unconscionably high at 220,000; and the Trump administration likely has underreported these deaths; more than 300,000 people have died this year than at the same time last year. The Trump administration also has failed to ensure that people have access to free tests with timely results or that health care workers have the personal protective equipment they need.
Pandemic management must start with the federal government, not with the states, as Vice-President Biden acknowledges. It must include universal health care coverage. But, pre-pandemic, 45 percent of working Americans were uninsured or underinsured, with unaffordable out-of-pocket costs.
Moreover, as the pandemic has made clear, we must end the tie between work and health care coverage if we are to ensure Americans access to needed health care. Tying health insurance to people’s jobs puts them at severe health risk when the economy turns and the job market shrinks.
If we don’t fix health care, we can’t fix financial or racial inequality. Yet, Gawande recognizes that a Biden administration has not yet committed to take the bold steps we will need to guarantee everyone access to care. Biden wants to build on the Affordable Care Act, which tends to offer health plans with few high-quality specialists and high out-of-pocket costs. Time will tell whether Biden’s version of a public health insurance option will guarantee people the reliable and affordable coverage they need.
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