More death, inequality: Trump presidency worsened US health, study says

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About 40% of the nation’s coronavirus deaths could have been prevented if the United States’ average death rate matched other industrialized nations, a new Lancet Commission report found.

While the Lancet Commission on Public Policy and Health in the Trump era faulted former President Donald Trump’s “inept and insufficient” response to COVID-19, its report said roots of the nation’s poor health outcomes are much deeper.

Commission co-chairs Dr. Steffie Woolhandler and Dr. David Himmelstein, professors at the City University of New York's Hunter College and longtime advocates for a single-payer health system such as Medicare for All, said the report published Thursday underscores decades of health, economic and social policies that have accelerated the nation’s disparities.

The report found U.S. life expectancy began trailing other industrialized nations four decades ago. In 2018, two years before the pandemic, the report said 461,000 fewer Americans would have died if U.S. mortality rates matched other Group of Seven nations: Canada, France, Germany, Italy, Japan and the United Kingdom.

“The overriding thing that we need to do in our country is to decrease the huge and widening inequalities that have emerged in our nation,” Himmelstein said.

COVID-19 has disproportionately affected people of color with the death rates among Blacks increasing 50% compared to whites. Coronavirus deaths for people of color are 1.2 to 3.6 times higher than for whites; the disparities were especially high among middle-aged adults, possibly a sign of crowded living conditions and jobs that did not allow people to safely distance, the report said.

Public health measures such as mask wearing and physical distancing could have saved lives, Woolhandler said, but Trump failed to create a national response, instead leaving crucial decisions to states.

His actions "caused a lot of citizens to fail to take it seriously and interfered with the kind of coordinated response they have been able to use in a lot of countries that are more successful than the U.S. in controlling the epidemic," Woolhandler said.

In addition to response to the COVID-19 pandemic, the report said Trump weakened the Affordable Care Act and 2.3 million more Americans became uninsured, a figure that does not include those who lost employer-provided coverage during the pandemic.

The commission took aim at Republicans and Democrats alike. The election of Ronald Reagan in 1980 marked the end of the New Deal and civil rights era in favor of "neoliberal policies" that eroded social programs, the report said. The report assailed Democrat Bill Clinton's support for tightening welfare eligibility and signing a federal crime bill that led to "mass incarceration," disproportionately harming Latinos and Black men.

Private insurers’ charged “exorbitant overhead and profits” when extending government-subsidized coverage to lower- and middle-income Americans under former President Barack Obama’s signature health care law, the report said.

The commission suggested a long list of executive orders and legislative actions to reverse trends negatively affecting the health of Americans. Among the fixes: Adopt a single-payer health system such as Medicare for All, championed by Sen. Bernie Sanders during his unsuccessful run for the Democratic Party’s presidential nomination.

“We’re still in a very deep hole. We have 30 million uninsured people. We have tens of millions of more who are underinsured,” said Woolhandler. “The thing that would be best for the health of the population would be Medicare for All.”

The commission’s wish list goes beyond medical care to include progressives ideals such as the Green New Deal, criminal justice reform, repealing Trump’s 2017 tax cuts and hiking spending on social programs to the levels of six other industrialized nations.

Biden has rejected Medicare for All and instead wants to bolster the Affordable Care Act with more lucrative subsidies for low- and middle-income earners. House Democrats unveiled a bill this week that would boost tax-credit subsidies for Americans who purchase marketplace plans. Biden already signed an executive order to reopen enrollment on HealthCare.gov from Feb. 15 through May 15.

In 2019, the Urban Institute estimated adopting a single-payer system such as Medicare for All would increase federal spending by $34 trillion over 10 years. The think tank has not updated the study, but Urban Institute Health Policy Center fellow and economist Linda Blumberg said health care spending increases each year.

Such an ambitious overhaul also would likely need to be gradual to minimize disruption to hospitals, doctors and patients. "If you were going to do it responsibly and you were going to phase it in over a period of time, that actually makes it cost more money," Blumberg said.

The commission said a single-payer system would save $626 billion each year on medical billing and administrative costs. While the report did not say how much Medicare for All would cost, it cited a study that found 20 of 22 models predicted total health spending would be less under a single-payer system.

In December, the Congressional Budget Office reported a single-payer plan would increase federal spending from $1.5 to $3 trillion in 2030 over projected levels. However, total public and private health-care spending could range from savings of $700 billion to an increase cost of $300 billion. The more optimistic scenario counts on administrative savings and health providers agreeing to lower payments.

"A Medicare for All program would substantially increase economic equality," Himmelstein said. "Poor people spend a much larger share of their incomes for their health care even though they get much less for their health care."