If the United States had death rates on par with other wealthy nations such as Canada and Japan, there would have been 40 percent fewer deaths attributed to COVID-19 last year. In 2018 alone, an estimated 461,000 fewer people would have died if the U.S. was as healthy as France or Germany.
The failure to contain COVID in the U.S. confirmed that our approach to health care and public health is broken, and former President Donald Trump made a bad situation worse. That’s the message from a multidisciplinary commission of experts assembled to study the Trump administration by The Lancet, a longstanding medical journal that has publicly tussled with Trump over the course of the pandemic.
Since 2017, the international team of 33 leading experts in clinical medicine, public health, epidemiology, community medicine, economics, nutrition, law, and politics has analyzed how the Trump administration’s policies impact our health. The result is a scathing and detailed new report that is an indictment of both Trump and a health care system that values profit over human life.
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The life expectancy in the U.S. began falling behind peers such as the United Kingdom, Germany and France when Ronald Reagan became president in 1980, according to Kevin Grumbach, a professor of family and community medicine at the University of California, San Fransisco and co-author of the report.
“That is the turning point where health started falling in the United States compared to the other G7 nations,” Grumbach said in an interview. “We totally shifted to conservative and neoliberal policies, and that corresponds with the deteriorating health in the country relative to other nations.”
Reagan instated policies that reduced the government’s role in health care and education and accelerated the concentration of wealth among the upper classes. Since then, life expectancy has dropped 3.4 years behind other wealthy countries and remains even lower among Black people and Native Americans. The report found that, before the pandemic, rates of midlife mortality among Black people and Native Americans were 42 and 59 percent higher, respectively, than for white people. People of color are more likely to die from COVID than white people, and the mortality gap between Black and white people has grown by 50 percent during the pandemic.
“The disastrous, bungled response to the pandemic made clear how existing, longstanding racial inequities simply have not been addressed,” said Mary T. Bassett, director of the FXB Center for Health and Human Rights at Harvard University and a member of the commission, in a statement.
Reagan’s neoliberal political philosophy stuck around under both Democratic and Republican administrations and created conditions for the rise of Trump. The report links health to trade liberalization that led to the outsourcing of manufacturing jobs, weakened unions and left many parts of the country to struggle economically. According to the report, Trump exploited anger among white voters over their “deteriorating life prospects,” and stoked racism and nativism to win the 2016 election.
“That’s the epidemic that we’ve been struggling through, not just through four years of Trump, but 40 years of failing to create the conditions that make for a healthy society,” Grumbach said.
As soon as he took office, Trump and Republicans in Congress moved to destroy the Affordable Care Act, which expanded health insurance for millions of people. The GOP’s signature achievement, a massive tax cut for the wealthy, opened holes in the federal budget that conservatives used to justify spending cuts on health and food assistance.
While attempts to repeal the Affordable Care Act failed spectacularly in Congress, the Trump administration used its executive powers to undermine the law. During the first three years of Trump tenure, the number of people with health coverage dropped by 2.3 million largely due Trump’s attacks on Medicaid, the program that provides health coverage to low-income people. About 760,000 kids and teens lost health coverage.
Before the pandemic hit, the Trump administration proposed $920 billion in Medicaid cuts and was poised to require burdensome eligibility checks that would have pushed more people out of the program, according to the report.
The Trump administration consistently favored corporate interests over public health when it came to climate and the environment and openly worked on behalf of the fossil fuel industry. The administration rolled back dozens of environmental regulations, allowing companies to spew more dangerous pollution into the air. Between 2016 and 2019, the number of deaths related to environmental and occupation hazards spiked to 22,000 after years of steady decline, according to the report. The administration also repeatedly attempted to suppress data showing the effects that pollution has on human health.
The list goes on, but the Trump administration’s response to the pandemic stands out. Grumbach said Trump had already cut staff at public health agencies by the time the pandemic hit, severely weakening the nation’s response. Meanwhile, Trump consistently spread disinformation about COVID, providing a preview of his efforts to overturn the election he lost to President Joe Biden. Attempting to deflect blame for a botched COVID response, Trump attacked China and World Health Organization (WHO), even citing The Lancet in a blistering letter to the WHO. The Lancet’s editor stepped in and confirmed that Trump was lying.
However, Grumbach said the problems exposed by COVID are bigger than Trump. Behind Trump’s bluster and weakness in the face of the virus is a neoliberal ideology that shapes our health care system and sets the U.S. apart from other nations, he said. It’s an ideology that values corporate profits over the lives of the vulnerable and sees health care as a commodity to be bought and sold rather than a human right. In such an environment, public health measures such as masking in public and providing health care to immigrants are subject to polarizing debate, even though they benefit everyone.
The Lancet’s commission concludes that simply returning to pre-Trump era policies will not be enough to protect health. Grumbach said the entire system needs an “overhaul.” For starters, the U.S. should transition to a single-payer health care system like those set up in nations such as Canada that have better life expectancy. Polling shows that 56 percent of likely voters in the U.S. support Medicare for All, the single-payer proposal championed by Sen. Bernie Sanders and other progressives. Support for a public option that would compete with private insurance is even higher, although many people support both.
The commission recommendations go far beyond the health care system. A massive mobilization of resources — a Green New Deal — is needed to confront climate change, which poses myriad threats to public health. The U.S. spends 3.4 percent of its GDP on the military, but G7 countries with lower mortality rates only spend an average of 1.4 percent of GDP on defense. If the U.S. reduced foreign intervention and military spending to 1.4 percent of GDP, a massive amount of resources could be redirected to urgent social needs. Additionally, the war on drugs must come to an end, and new investments should be made in communities of color harmed by the criminal legal system and mass incarceration, according to the commission.
“While the wealthy have thrived, most Americans have lost ground, both economically and medically,” said Steffie Woolhandler, who co-chairs The Lancet’s commission and lectures at Hunter College and Harvard. “The Biden administration must reboot democracy and implement the progressive social and health policies needed to put the country on the road to better health.”