As People Keep Dying, Can the President--Can We--Really Say 'We Did Everything We Could'?

I was moved by President Biden's speech marking the half-million-life milestone in US pandemic deaths. I disagree with him on a lot of issues, but he strikes me as a decent person. He's been through more grief than anyone should have to endure. I respect and mourn his experience with loss, which he speaks about with eloquence and wisdom.

Two things the president said especially caught my attention. One was, "We have to resist becoming numb to the sorrow," The other was, "We have to resist viewing each life as a statistic or a blur on the news."

That's an awareness we all need to cultivate, but it carries a profound ethical obligation. Each of us - President Biden, Congress, you, me - should be able to say of everyone who has died or who will die in the future: I did my best to save them.

"I don't expect the president or his advisors to have a Road to Damascus moment and become Medicare for All supporters. But they've offered no alternative plan, no deadline, no date when the needless deaths must stop. And so, our friends and neighbors keep dying."

Nothing less will do. As a nation, as a society, we've settled instead for half measures. That leaves us with the moral stature of someone who could have saved a drowning person but didn't want to get their shoes wet.

Today, Rep. Pramila Jayapal introduced the latest Medicare For All bill in the House of Representatives. More than half of her fellow House Democrats joined her in co-sponsoring that bill, which is an exciting sign of progress. But it won't become law without more support from the Democratic leadership - and it will take more grassroots organizing to make that happen.

This session of Congress is also likely to see the reintroduction of last year's Health Care Emergency Guarantee Act from Rep. Jayapal and Sen. Bernie Sanders, which would cover all out-of-pocket health care costs for the duration of the pandemic. Unless someone has a better idea for saving lives, these bills carry the weight of moral imperative.

A new report from Public Citizen released this week, concurrent with the new Medicare For All launch in the U.S. House, is called "Unprepared for COVID-19: How the Pandemic Makes the Case for Medicare for All." And the medical journal Lancet recently published a study showing that 40 percent of the country's COVID-19 deaths during the Trump era could have been prevented. While the Lancet paper appropriately places much of the blame at Trump's feet, it also makes this important observation: "Although Trump's actions were singularly damaging, many of them represent an aggressive acceleration of neoliberal policies that date back 40 years."

Over four decades, under Democratic as well as Republican governments, our country has relentlessly rolled the social safety net instead of expanding it. Many people have died as a result. Which raises that question, for the leaders of those administrations and for the rest of us: Did we do enough to save them?

The Lancet study also makes this important observation: "Despite the Affordable Care Act, nearly 30 million people in the USA remained uninsured and many more were covered but still unable to afford care."

Uninsurance kills. In the decade before Covid-19, hundreds of thousands of deaths were caused by our privatized insurance "system." How many lives does that cost us each year? A 2009 study by Drs. David Himmelstein and Steffie Woolhandler estimated that 45,000 Americans died every year because they didn't have insurance.

The CBO estimates the American Rescue Plan will add 1.7 million people to the insurance rolls, while reducing costs for others. With nearly 30 million people uninsured before the pandemic, that would leave roughly 28 million people uninsured. Using calculations from a 2017 paper by Himmelstein and Woolhandler, that would result in more than 20,000 unnecessary deaths this year alone, and more than 200,000 over ten years. Even if the uninsured rate was cut in half, deaths from uninsurance would reach six figures over the next decade.

In one sense, these numbers are "statistics, a blur on the news." On a human level, each death leaves "an empty chair around the kitchen table," to use President Biden's compassionate words. And that doesn't include deaths from under-insurance - the people who had "good" insurance but couldn't afford their plan's copayments or deductibles. Many people remember the young Texas teacher who died because she didn't feel she could afford $116 for her flu medication. She had "insurance," but she wasn't insured enough. As far as I know, such deaths have yet to be accurately measured.

The actuarial firm Milliman calculates that the average family of four with health insurance--a "good" employer plan, with more generous benefits than many plans on the ACA exchanges--paid $12,285 for its share of health care costs in 2020. How many families have that much to spare in this plague-battered economy? The rescue plan's COBRA provision transfers yet more billions to for-profit insurers, only applies to the recently unemployed, and perpetuates other forms of inequality. And most of the people who retain coverage under this program will pay those high out-of-pocket costs. (Diane Archer and I have more on that here.)

Statistically, many (perhaps most) insured Americans will still face the possibility of having to choose between other basic financial needs or doing without needed care. That's a choice no family should have to make.

"Still, some liberal critics insist that we should move slowly and incrementally toward universal medical access. How that happens is never very clear; it's like adding gears to a bicycle and expecting it to become a car."

Democratic critics of single-payer care raise real concerns. It will save money for the overall economy, but it will be a major shift from the private to the public economy. Its implementation will take planning and effort. But these impediments are minor, especially when compared to the loss of human lives. We'll save money overall, and we have lots of competent people who can help implement the plan. It took less than a year to get Medicare up and running in the mid-1960s, a primitive era for information technology.

Still, some liberal critics insist that we should move slowly and incrementally toward universal medical access. How that happens is never very clear; it's like adding gears to a bicycle and expecting it to become a car.

I don't expect the president or his advisors to have a Road to Damascus moment and become Medicare for All supporters. But they've offered no alternative plan, no deadline, no date when the needless deaths must stop. And so, our friends and neighbors keep dying.

Let's hope that, someday, the compassion and urgency of the president's remarks are reflected in our nation's policies. And that most of us will be able to face the families of those we've lost in the meantime and say, "I did everything I could to save them."