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A damning new study by the Lancet, one of the world’s leading medical journals, found that Donald Trump’s handling of the coronavirus pandemic while he was president exacerbated problems that had been accruing over four decades of government neglect, leading to Americans dying of COVID-19 at a higher rate than people in other high-income nations.
The report commissioned by the Lancet, a British publication, laid out how years of declining spending on public health and an increase in wealth inequality combined with COVID-19 to cause avoidable deaths in the United States, with a disproportionate effect on minority communities. The authors found that 40 percent of the more than 400,000 American virus deaths as of mid-January could have been averted if the U.S. had a mortality rate in line with those of the other G-7 nations (Canada, France, Germany, Italy, Japan and the U.K.).
The Lancet Commission on Public Policy and Health in the Trump Era found that the former president’s actions resulted in 2.3 million Americans losing their health insurance during his tenure, in addition to the nearly 30 million who weren’t covered when he took office. It also stated that his rollbacks of environmental regulations resulted in an increase in pollution that led to an estimated 22,000 additional deaths in 2019 alone.
The study stands out from other recent reports in that it places blame for a large number of deaths not just on Trump’s policies, but also on the American health care system more generally. Trump’s response to the pandemic, though, came in for the most criticism.
“Instead of galvanizing the US populace to fight the pandemic, President Trump publicly dismissed its threat (despite privately acknowledging it), discouraged action as infection spread, and eschewed international cooperation,” read the report. “His refusal to develop a national strategy worsened shortages of personal protective equipment and diagnostic tests. President Trump politicized mask-wearing and school reopenings and convened indoor events attended by thousands, where masks were discouraged and physical distancing was impossible.”
The study also found that the pandemic increased the mortality gap between Black and white Americans by 50 percent and cut the life expectancy of Latinos by nearly four years. It stated that “the fact that COVID-19 affects Black, Indigenous, and Latinx people disproportionately has reinforced longstanding health inequities driven by racially patterned disparities in housing, wealth, employment, and social and political rights.”
The country’s treatment of Puerto Rico, specifically in the wake of 2017’s Hurricane Maria, was highlighted as particularly neglectful, as well as the militarization of immigration policies, which the report said “harmed the health and development of thousands of children and intimidated immigrant communities, discouraging them from using health and nutrition services.”
While the authors of the study were critical of Trump’s handling of the virus and his overall governing philosophy, they repeatedly stated that there were deep problems in the country before 2017, blaming “neoliberal” policies that resulted in cuts in government spending on public health and the lack of universal insurance.
“The disturbing truth is that many of President Trump’s policies do not represent a radical break with the past but have merely accelerated the decades-long trend of lagging life expectancy that reflects deep and longstanding flaws in US economic, health, and social policy,” read the report. “These flaws are not only evident in faltering longevity — and the especially sluggish progress in reducing deaths amenable to health care — but also in the widening gaps in mortality across social class and geography and the chronically high mortality of Black and Indigenous people.”
The report found that the average life expectancy in the U.S. began to fall behind those of other high-income nations in the 1980s, which it attributed to rollbacks of New Deal and Great Society anti-poverty programs under the Reagan administration. Further deterioration followed, as average life expectancy in the country actually declined between 2014 and 2018, “a period that included the first 3-year decline in longevity since World War 1 and the 1918 flu pandemic.”
“What was so unprecedented about that decline is that the economy was booming at that point,” Dr. Steffie Woolhandler, a co-chair on the commission and a Distinguished Professor of Public Health at the City University of New York at Hunter College, told Yahoo News. “Usually when the economy gets better, life expectancy improves rapidly, but there was this decoupling of the overall economy from the overall well-being of the population as measured by life expectancy. That is the condition that existed in the United States before COVID hit. Now, what do we think happened? We think it was four decades of failures of policymakers.”
Former President Bill Clinton’s tenure was also criticized in the report for the passage of a strict crime bill that disproportionately affected minority communities, the weakening of unions and financial regulations, trade deals that resulted in American job losses, and restrictions on welfare benefits and nutrition assistance. The authors noted that while former President Barack Obama campaigned on expanding health care coverage, the Affordable Care Act “owed more to neoliberal tenets than to the progressive precepts of the Roosevelt era.” Some 30 million people were still left without health insurance under the act, known as Obamacare, while sending public money to private health insurance companies, they wrote.
The authors stated that due to some metrics — such as Trump having a higher vote share in counties with lower life expectancies and Republicans doing better in majority-white districts where jobs were lost due to trade policies — it’s their belief that the hollowing of the health care system combined with GOP messaging on race drove more votes to Republicans. In contrast, the report found that job losses in majority nonwhite districts led to voters choosing more liberal Democrats, finding that “the divergent responses of white and non-white voters to economic distress signals the power of diversionary racist and nativist appeals.”
The editors of the report stated that taxes on high-income earners should be raised, with the proceeds going to social, education, health and environmental programs. In addition, they called for a national health insurance program to replace the means-tested Medicaid system, and for mobilization against structural racism and police violence that “shorten the lives of people of color.”
They also suggested ending the channeling of public funds through private companies and instead redirecting public investment from the military and corporate subsidies to environmental protection and neglected public health and social programs.
President Biden’s proposed plan of adding a public option to Obamacare (in which the government would offer a plan on the market to buy into) and lowering the Medicare eligibility age from 65 to 60 falls short of the commission’s recommendation. As the authors stated, “Many people covered by Medicare or private insurance would still face onerous co-pays (ie, an out-of-pocket payment required for each service) and deductibles, and millions of people would remain uninsured,” while the presence of private insurers would keep health care administrative costs in the hundreds of billions.
A separate 2019 analysis found that Biden’s proposed plan would result in an additional 125,000 deaths vs. universal coverage over its first decade due to millions of Americans lacking coverage.
The policies recommended by the Lancet commission, even if politically impractical, appear to have public opinion 0n their side. Polling from the Kaiser Family Foundation has shown majority support for an increased government role in providing health care, in line with a September 2020 Pew Research survey that found 63 percent of respondents believe it’s the federal government’s responsibility to make sure all Americans have health care coverage. A December 2020 survey conducted by the New York Times found 67 percent of Americans — including 45 percent of Republicans — support higher taxes on those making $400,000 or more, while a January 2020 Reuters poll showed 64 percent support for a wealth tax.
“I do actually think the potential is there for the COVID pandemic to inspire people to think more deeply about the structural problems,” Woolhandler, the commission co-chair, said. “The commission is saying if they think these things through, think about how the situation has deteriorated over the last four decades, and it’s not going to be enough to just reverse what Trump did.”
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