Trump versus Biden: a fight for the health of a nation

Health

Trump versus Biden: a fight for the health of a nation

Editor2

August 21, 2020

Trump versus Biden: a fight for the health of a nation

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With only 73 days until Nov 3, the 2020 presidential election in the US has entered a decisive phase with Democratic candidate Joe Biden’s announcement of California Senator Kamala Harris as his running mate. It comes against the backdrop of the COVID-19 pandemic that has revealed a nation of stark inequity, especially in terms of health. Over the past three decades, non-communicable diseases, especially cardiovascular diseases, cancers, neurological disorders, chronic respiratory diseases, diabetes, and chronic kidney disease have been the predominant causes of death and disability in the US. High blood pressure, high body-mass index, and smoking have ranked among the top risk factors for poor health since 1990. Yet this bleak picture of US health has been considered in previous elections mainly as it relates to access to health care.

The 2010 Affordable Care Act (ACA) codified a set of ten essential health benefits that insurance plans must provide, including preventive health services, pregnancy and maternity care, and mental health services. Importantly, the ACA also eliminated pre-existing condition bans. The law aimed to greatly increase the number of those insured in the US through a mix of Government-provided insurance, such as Medicaid, and private insurance with employer and state-run health-care market places. A recently published 2020 Commonwealth Fund report shows that before the major provisions of the ACA were introduced, the US had worse outcomes and spent more on health care than after, but also had the lowest life expectancy, highest suicide rate (13·9 per 100 000 population, compared with an OECD average of 11·5), and the highest rate of avoidable deaths of all OECD countries. The US also has the highest chronic disease burden and an obesity rate of 40%, which is twice as high as the OECD average.

In 2017, the number of uninsured people increased for the first time since implementation of the ACA—to 27·4 million people. Those most at risk of being uninsured include persons with low incomes and people of colour. Because coverage is still associated with the ability to pay, the cost of coverage continues to be the most commonly cited barrier to accessing care. Over half of Americans are insured through their employers and the massive loss of jobs because of COVID-19 has led to millions more Americans becoming uninsured. Biden has called for strengthening and expanding the ACA, but there is little incentive in Congress to move towards a single-provider health-care system. The US must move away from a system in which health care is politicised, contentious, and tied to employment, income, and immigration status. In addition, President Trump’s isolationist and anti-scientific adminstration has de-prioritised health and health care.

Decisions made by the next administration will affect the lives of all people in the US and around the world. For this reason, we invite both political parties to articulate their positions on the following urgent priorities.

COVID-19. In light of the devastating effects of this pandemic, accentuated by the pre-existing epidemics of chronic disease, will you commit to enact truly universal health coverage to protect the health and wellbeing of the American people? If so, how?

Health inequalities. Given the growing and disfiguring health disparities across the country, combined with burgeoning levels of racial and gender injustice, will you commit to making the reduction of health inequalities, and the social determinants of those inequalities, one of your major domestic objectives? If so, what specific actions will you take?

Public health. Given the critical importance of the Centers for Disease Control and Prevention to domestic health and global health security, will you commit to investing in and strengthening this vital national public health agency? If so, by how much?

Global health. Given the importance of the international leadership role of the US in health and medicine, will you commit to returning as a fully participating member of multilateral health institutions, such as WHO?

Medical research. Will you commit to accelerating funding for medical and public health research? The current President’s budget proposal for 2021, called for a 7% cut in National Institutes of Health (NIH) spending. Do you agree that a strong research base is a powerful means to ensure the long-term health of the nation? If so, how much will you commit to invest in NIH?

If logic and justice prevail in the next presidential administration, universal health coverage, a fairer society, stronger health institutions, more energetic global engagement, and a robust research agenda will be the foundations for America’s renewal. We all have a stake in America’s success.