A panel of policy experts and medical professionals convened to examine the healthcare legacy of Donald Trump concluded in a detailed report released Thursday morning that the former president's sweeping regulatory rollbacks and full-scale assault on America's already decimated public health infrastructure severely undermined the nation's fight against Covid-19 and caused tens of thousands of preventable deaths.
Described as the first comprehensive look at the consequences of the former president's four years of corporate-friendly privatization efforts, deep cuts to public health programs, and abandonment of international cooperation in the midst of the coronavirus pandemic, the new study by the Lancet Commission on Public Policy and Health in the Trump Era argues that while the Republican's tenure was in some ways uniquely destructive, his agenda built upon years of "damaging neoliberal policies" pursued by his predecessors.
"While the wealthy have thrived, most Americans have lost ground, both economically and medically. 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."
—Dr. Steffie Woolhandler
"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 long-standing flaws in U.S. economic, health, and social policy," reads the report, the product of years of research by dozens of leading health experts from the U.S., U.K., and Canada.
The 49-page assessment notes that while Trump and his GOP allies failed in their effort to repeal the Affordable Care Act, the number of U.S. residents without health insurance coverage soared by 2.3 million during the former president's first three years in office largely due to his assault on Medicaid, a program that has long been in the crosshairs of Republican lawmakers.
"Over the past four years," the report notes, "the Trump administration gradually advanced its market-based agenda, including efforts to divert funds from the Veterans Health Administration (VA) to purchase private care for veterans and, most prominently, by pushing forward the creeping privatization of Medicare that started with the Reagan administration."
The Trump administration's sprawling attack on America's public health programs helped set the stage for the White House's disastrous response to the coronavirus pandemic, which hit the nation after many of the former president's healthcare rollbacks had taken their toll, leaving millions of additional Americans vulnerable to the virus and its widespread economic consequences. As of this writing, the virus has killed more than 471,000 people in the U.S.
"Instead of galvanizing the U.S. populace to fight the pandemic," the report states, "President 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."
Stressing that the Trump administration impacted public health through a variety of means, the Lancet panel's study estimates that the former president's gutting of environmental regulations was responsible for 22,000 excess deaths in 2019 alone.
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Trump's massive tax cuts for the rich and corporations, moreover, contributed to decades of soaring income and wealth inequality, a trend that has further stratified U.S. society and left large segments of the population unable to afford the basic necessities of life—including adequate healthcare, food, and housing. The commission also pointed to the president's racism, xenophobia, and attacks on women's reproductive rights as immensely damaging to U.S. public health.
Beginning to undo some of the devastation inflicted by Trump and those who laid the groundwork for his ascendancy will require much more than a return to a status quo under which tens of millions were uninsured, hungry, and poor, the experts behind the study argue.
"Trump's disastrous actions compounded longstanding failures in health policy in the USA," said panel member Dr. Kevin Grumbach, Hellman Endowed Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco. "We know what it will take to create a healthy society. We just need the political will to do it."
Among the panel's list of policy recommendations is Medicare for All, a system that would "cover all residents under a single, federally financed plan providing comprehensive coverage" at a lower cost than the current fragmented, for-profit system. President Joe Biden opposes Medicare for All and has instead proposed more incremental reforms like a public option, an approach the commission warns would leave many with "onerous co-pays... and deductibles, and millions of people would remain uninsured."
"Our ICU is the last stop for many patients harmed by Trump's disdain for facts, science, and compassion," commission member Dr. Adam Gaffney, a pulmonary and critical care specialist at Cambridge Health Alliance and Harvard Medical School, said in a statement. "But decades of health care inequality, privatization, and profiteering set the stage for these tragedies. Our commission has concluded that single-payer, Medicare for All reform is the only way forward."
The commission's list of policy recommendations also includes:
- Repealing Trump's tax cuts and raising taxes on the wealthy;
- Slashing military spending;
- Passage of a Green New Deal ending subsidies to the fossil fuel industry;
- Reversing cuts to the Centers for Disease Control and Prevention and other public health agencies;
- Making school meals free and universal;
- Raising the federal minimum wage; and
- Eliminating "patents, trade agreement restrictions, and treaties that impede global access to vital generic drugs."
"Americans' health was deteriorating even as our economy was booming," said Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and a distinguished professor of public health at City University of New York at Hunter College.
"This unprecedented decoupling of health from national wealth signals that our society is sick," added Woolhandler, a co-chair of the Lancet commission. "While the wealthy have thrived, most Americans have lost ground, both economically and medically. 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."