-----Original Message-----
From: Eric Russell <ericprussell@xxxxxxxxxxx>
To: uupretirees@xxxxxxxxxxxxx <uupretirees@xxxxxxxxxxxxx>
Sent: Sat, Feb 20, 2021 8:53 pm
Subject: [uupretirees] A study of life trends and medical care in America and
the world
#yiv4725375931 P {margin-top:0;margin-bottom:0;}It's long but worth your time.
It covers a lot more than COVID and is damning of both parties. Eric
A commission set out to study Trump’s abysmal COVID policies. Their report is
an indictment of the entire US system
Donald Trump is greeted by President Ronald Reagan at a 1987 White House
reception, White House photographer. Igor Derysh and Salon February 14, 2021
About 40% of coronavirus deaths under President Donald Trump were avoidable —
but even the total number of U.S. pandemic deaths last year is dwarfed by the
annual number of preventable deaths caused by four decades of racist and
pro-corporate policies, according to a new Lancet Commission report.Months into
Trump's presidency, dozens of medical experts formed a commission to study the
health impacts of his policies for The Lancet, a highly-respected British
medical journal. The Lancet Commission on Public Policy and Health in the Trump
Era found that roughly 40% of coronavirus deaths in the United States could
have been prevented if the average death rate matched that of other wealthy
nations.ADVERTISING"We became concerned that even within a few weeks of him
coming into office he had started to implement policies which we thought would
be deadly," Dr. Steffie Woolhandler, a health policy expert at the CUNY School
of Public Health at Hunter College and co-chair of the commission, said in an
interview with Salon. "And now that we're in 2021, we have actual data and, in
fact, his policy has been very deadly."Instead of galvanizing the public to
fight the pandemic, the report said, Trump "publicly dismissed its threat
(despite privately acknowledging it), discouraged action as infection spread,
and eschewed international cooperation.""His refusal to develop a national
strategy worsened shortages of personal protective equipment and diagnostic
tests," the researchers added. "President Trump politicized mask-wearing and
school re-openings and convened indoor events attended by thousands, where
masks were discouraged and physical distancing was impossible."00:5601:44But
the commission went further, finding that life expectancy in the U.S. has
diverged from other major industrial nations since the 1980s, despite
continuous economic growth. As a result, the country sees more unnecessary
deaths each year than all the 2020 coronavirus deaths combined."In 2018,
461,000 Americans died who would still be alive if our life expectancy were as
long as in other wealthy nations," Woolhandler said. "So COVID killed about
400,000 people in 2020, which was horrible. But every single year, the United
States was losing that many people relative to other developed nations, because
our policymakers had failed to create the conditions for health."There's little
doubt that the coronavirus pandemic and Trump's mismanagement has significantly
worsened that trend, particularly in communities of color. The pandemic has
increased the life expectancy gap between Black and white people by more than
50%, the report said. The average Latino life expectancy in the U.S. has fallen
by 3.5 years since the start of the pandemic."Overall, in the USA, Black and
Latinx people have incurred more total years of potential life lost than white
people because of COVID-19, although the white population is three to four
times larger," the researchers wrote."The strong focus on racism in all its
forms and its impact on almost every area of public policy is very important,"
Richard Gottfried, chair of the New York State Assembly's health committee and
a member of the commission, said in an interview with Salon, adding that many
Americans "may not fully understand the all-pervasive nature of the impact of
racism."Even before the pandemic hit America, Trump's policies were linked to
an increase in preventable deaths. Despite repeatedly failing to repeal
Obamacare, Trump undermined the program in various ways and the number of
uninsured Americans increased by 2.3 million before the pandemic, a number that
rose further amid rampant job losses during the health crisis. He used the
deficit caused by the 2017 tax cut that primarily benefited the wealthy and
corporations to "justify cutting food subsidies and health care," the report
said. His deregulation agenda worsened pollution, "resulting in more than
22,000 extra deaths in 2019 alone."Trump's "disdain for science" and cuts to
global health programs and public health agencies hampered the coronavirus
response, "causing tens of thousands of unnecessary deaths," according to the
report, and those cuts "imperil advances against HIV and other diseases."But
the researchers warned that "focusing narrowly on Trump's policies and
rhetoric, while ignoring the failings that precipitated his election, risks
obscuring the causes and remedies for the longterm downward trajectory of
health" in the United States."The disturbing truth is that many of President
Trump's policies do not represent a radical break with the past but merely
accelerated the decades-long trend of lagging life expectancy that reflects
deep and long-standing flaws in US economic, health, and social policy," the
report said.In fact, Trump's county-level vote share was closely correlated
with worsening life expectancy trends. Counties where more than 60% of voters
backed Trump had higher life expectancy in 1980 than counties where Clinton won
more than 60% of the vote, according to a 2017 study. But in 2014, the Trump
counties had an average life expectancy two years lower than the average
Clinton county."People's deteriorating life prospects appeared to be feeding
unhappiness and dissatisfaction that Trump was able to adequately cynically
mobilize for his own purposes," Woolhandler said.Many lower-income white people
with "deteriorating life prospects" have gravitated toward Republican policies
because they believe people of color disproportionately benefit from expansions
of public health and social safety nets, even though they themselves would
greatly benefit from policies that improve public health."Ironically, the
ascendance of right-wing populism and Trump's weakening of the US Government's
role in protecting health are likely to exacerbate the income and place-based
health disparities that harm many of his voters," the report said. "A negative
feedback loop — with low-income white people helping to stifle demands for
vital public investments — risks inflicting additional and long-lasting damage
to their health and wellbeing."Trump, the researchers argued, used this racial
animus to "deflect attention from policies that abet billionaires' accretion of
wealth and power," arguing that his America First narrative "camouflaged
policies that enriched people who were already very wealthy and gave
corporations license to degrade the environment for financial gain."Meanwhile,
the report said, Trump "halted progress in almost every domain, undermined care
for low-income people and the middle class, weakened pandemic preparedness;
withheld food and shelter from those in need, and persecuted those who were
vulnerable and oppressed."But Trump is obviously not the first president to
push the privatization of public services and deregulation aimed at helping
corporations maximize profits. Arguably every president since at least Jimmy
Carter has played a role in that process."Although Trump's actions were
singularly damaging, many of them represent an aggressive acceleration of
neoliberal policies that date back 40 years," the report said. As a result of
policies that chipped away at New Deal and Civil Rights-era progress, the
"widening income inequality has widened inequalities in health."The deepening
inequality began in earnest during the Reagan era as unions were "stifled," the
tax code and government policies increasingly favored the wealthy, and
high-paying manufacturing jobs began to disappear, the report said. Despite a
booming stock market and low unemployment, the report added, many people have
been "forced into precarious jobs that offered low pay and insufficient
benefits."After Reagan's election, "we saw U.S. life expectancy begin to lag
[and] health care costs begin to soar," Woolhandler said. In 1980, American
life expectancy was around the average for developed nations. By the time the
pandemic hit, U.S. life expectancy was 3.4 years below the G7 average,
according to the commission.The damaging policies were not limited to
Republicans. Through Bill Clinton rejected many Reagan-era policies, he
expanded trade agreements that weakened protections and unions and imposed
restrictions on welfare and food benefits. He also signed bills that expanded
mass incarceration and worsened wealth and income inequality."A major problem
with trade policies has been that they made drugs too expensive," Woolhandler
said.Though Barack Obama expanded health coverage, his signature health program
funneled money through private profit-seeking companies and exploded
out-of-pocket costs.Between 2002 and 2019, the share of public health spending
in the U.S. fell from around 3.1% of the GDP to 2.45%, roughly half the
proportion in Canada and the U.K."Market-oriented health policies shifted
medical resources toward high-income people, burdened the middle class with
unaffordable out-of-pocket costs and deployed public money to stimulate the
corporate takeover of vital health resources," the report said.Although the
Affordable Care Act expanded health coverage to tens of millions more people,
the program still left between 25 million and 30 million uninsured before Trump
took office. Despite the coverage expansion and a booming economy since 2010,
"there's been essentially no improvement in Americans' life expectancy, which
is all the more shocking," Woolhandler said."That is really historically
unprecedented, because usually when the economy grows, life expectancy grows,"
she said. "It's good for you to have more resources. But in the United States,
we actually have an uncoupling of life expectancy growth from economic
growth."The decline in life expectancy has been especially stark in communities
of color. Life expectancy for Black Americans is about 3.4 years shorter than
for white people. Life expectancy among Native Americans is poorest of all,
Woolhandler observed, saying these statistics "are related to structural white
supremacy."The report found that all people of color except Asian Americans
receive significantly less medical care than white Americans despite having
worse life expectancy and seemingly greater need. Mass incarceration, the drug
war and police violence are also major factors in the lagging life expectancy
of people of color. The report cited estimates that roughly one in every 1,000
Black men will be killed by police, a rate 250% higher than that of white
males. While discourse around the opioid epidemic has largely focused on drug
use among white people, Black Americans saw the sharpest increase in opioid
deaths between 2012 and 2018, a problem that has likely been exacerbated during
the pandemic due to economic stress and social isolation."We still have an
unequal society based on a history of white supremacy with discriminatory
treatment continuing to this very day," Woolhandler said. "That's something
that needs to be changed. We concluded that racism is obviously bad for the
health of people of color, but also that we think it threatens everyone."Racism
has been manipulated by cynical politicians like Trump to encourage low-income
white people to oppose social services. They're opposing social services in the
mistaken belief that they only benefit people of color. So low-income whites
are often mobilized against their own self-interest on services that would
benefit them personally, opposing it just for people of color. So racism harms
health directly for people of color, but also harms health by poisoning the
political climate that we need in order to get our government to act."The
commission's report included dozens of recommendations for President Biden's
administration and lawmakers, many of them focused on addressing the racial
inequities in public health. But the extent of these policies shows that
Congress and Biden need to "go beyond simply repairing Trump's damage," the
report said."Racism has a profound impact on what health care providers are
available in communities of color and their access to it," Gottfried said. "It
denies people full health coverage disproportionately and has an impact on the
quality of care that's available in their neighborhoods. And you see the
results in shocking data on infant and maternal mortality and life expectancy
and almost every measure of health care quality and bad outcomes."The
researchers called on lawmakers to address structural racism, decriminalize
drug use, and reform policing and criminal justice systems that "oppress"
communities of color and "fill prisons." The recommendations also include
addressing policies that suppress voters, particularly voters of color, and
creating a National Center on Anti-Racism and Health within the Centers for
Disease Control and Prevention. The commission also called for reparations to
African Americans, Native Americans and residents of Puerto Rico "for the
wealth and education confiscated from (or denied to) those groups in the
past.""To repair health deficits in the USA, we must redistribute wealth and
income through taxation, fortify social programmes and regulation, remediate
the structural racism that afflicts Black, Latinx, and Indigenous people, and
heal US democracy by eliminating obstructions to voting," the report said.The
report also called on lawmakers to address the worsening pollution caused by
Trump's deregulation of environmental regulations and to mobilize "massive
resources to avert climate catastrophe."Funding for these major reforms could
come from redirecting resources from the military, raising taxes on the
wealthy, and ending corporate subsidies and programs that funnel public funds
through private companies.At the heart of the report's recommendations is the
need for a universal health care program that does not allow tens of millions
of people to be denied coverage while forcing tens of millions of others to pay
skyrocketing out-of-pocket costs that lead to bankruptcies and avoidance of
medical care."Almost every problem we face in health and health care, whether
as patients or providers or employers or taxpayers, is made much worse and much
harder to solve because of the way we pay for health care in America," said
Gottfried.Gottfried has sponsored a single-payer health care bill called the
New York Health Act in the state legislature for nearly three full
decades."Really the only solution to the coverage problem that is effective is
a single-payer system," he said. "Everything else leaves us with gaps and a
fragmented system and all the wasted spending that is caused by a fragmented
system dominated by insurance companies. … Getting rid of that waste would
generate enough money to provide complete coverage for everyone, including
long-term care. Until we get rid of that waste, it is virtually impossible to
achieve high-quality and equitable healthcare."A study by Woolhandler and
fellow commission co-chair Dr. David Himmelstein last year found that
eliminating overhead and administration costs from health care spending by
transitioning to a government-run health care program similar to Canada's would
save enough money to pay for the entire cost of the program. Woolhandler and
Himmelstein are also the co-founders of Physicians for a National Health
Program, which has long advocated for a single-payer system. Their findings
were echoed in another study published last year in The Lancet and a review of
22 studies published in PLOS Medicine.Biden has made clear that he opposes a
Medicare for All-style single-payer system, although he has vowed to expand
Obamacare. Gottfried said that progress will first likely have to come at the
state level if New York and others can pass bills like his single-payer
proposal."I think the most we can expect from the Biden administration is
cooperation with states that want to do single-payer systems," he said. "I
believe New York can implement single-payer coverage even without federal
cooperation. It would be more complicated, but we can do it."In Canada,
Gottfried observed, single-payer health insurance "began in one province and
then another province joined in and in just a few years it became a
provincial-based program but funded largely with federal money." He suggested
that the same could happen in the U.S. "After one state enacts it, you'll see
more states doing it. Eventually, either there will be a national program or
there will be federal funding to help support state single-payer programs."The
commission's report included numerous immediate reforms the Biden
administration could use to improve public health en route to an eventual
single-payer system, including providing incentives for states to expand
Medicaid if they have yet to do so — primarily in the South where half of
America's Black population lives. The commission also recommended rolling back
all Trump's efforts to undermine Obamacare and undoing his expansion of the
public charge immigration rule."The public charge rule is a long-standing
immigration term that originally just applied to people who receive cash
benefits and who resided in long-term care institutions paid for at government
expense," Woolhandler said. "Trump has expanded that rule so that it can
encompass virtually any use of public benefits, and that has really frightened
many people in immigrant communities. People are afraid to enroll themselves or
their children in Medicaid. They're afraid to use nutrition benefits. They're
afraid to seek housing benefits, and those things are very important for
health."Biden quickly signed dozens of executive actions to roll back many of
Trump's policies related to health care, immigration, climate and racial
equity, and plans additional executive orders and legislation to undo Trump's
damage. But the commission emphasized that correcting inequity will require
much more than rolling back four years of Republican policies."Policymakers are
going to have to create the conditions that allow my patients to be healthy,"
said Woolhandler, who is also a practicing primary care physician. "We need to
change the direction of American public policy to make sure that people's needs
are met, and that the conditions for their health are met."If we fail to do
that, we're going to continue to see people feeling desperate, see people
feeling angry. Those are the conditions that allow the rise of autocratic
leaders like Trump. So Trump may be gone, but Trumpism will come back and cause
problems for us unless we build a society that actually takes care of people."
