William S. Becker is executive director of the Presidential Climate Action Project and co-editor of Democracy Unchained: How to Rebuild Government for the People (The New Press, 2020). He previously served as a senior official at the U.S. Department of Energy, and remains an advisor to several policy organizations and think tanks.March 31, 2020
The most important issue in the November election is clear now, and it extends to every level of elective government in the United States. It can be expressed in two words –– be prepared. Be prepared for health emergencies because there will be more. Be prepared for global climate change because it is developing fast. And be prepared to hold incumbent Republicans accountable for the fact that America is woefully unprepared for both.
It's about more than COVID-19. Over the last four years, Republicans have forfeited the right to lead. This is not a partisan judgment. It is what it is.
Let's start with the virus. It has been 94 days since China announced the outbreak of the coronavirus and 70 days since the first case was confirmed in the United States. Yet first responders and medical workers are still without the personal protection and equipment they need to treat the sick. In some cities, they must let the sickest die so other people can be saved.
Assessments already are coming in on why we were not better prepared and how our leaders responded once they knew COVID-19 was spreading. President Trump has already proved he is someone we cannot trust or count on in a crisis of this magnitude. He is more concerned about reelection than about us.
There will be time for a more thorough post-mortem on the government’s actions later this year. The highest priority now is as it has been for more than two months: Get equipment and supplies to the medical personnel and first responders who are trying to save our lives without sacrificing their own. It is mind-boggling that a particle smaller than a bacterium has brought down the world’s largest economy when it was in full boom; that we were virtually defenseless at every level of government; and that we are so unable to get ahead of the crisis that we are still losing the battle now.
Then there's the never-ending problem of affordable health care in general. Democrats running for president have talked repeatedly about the need to make health insurance affordable and available to the tens of millions of families that do not have it. The situation has never been so clearly an issue of income inequality as it is now.
Bernie Sanders favors Medicare for all, expanded to cover everything from prescription drugs to long-term care, mental health, and inpatient and outpatient care. That’s in direct contrast to President Trump. In early February, he tweeted that his 2021 budget “will not be touching your Social Security or Medicare”. Days later, he released a budget that would cut Medicare by $850 billion, Medicaid by $920 billion and Social Security by $30 billion. It also included a cut of more than $690 billion for the Centers for Disease Control, a reduction the White House still supports despite the coronavirus crisis.
These cuts will not be approved by Congress, but Trump’s latest budget should be understood as his plan for a second term.
Trump repeatedly promised to replace the Affordable Care Act (ACA, aka Obamacare) with his own beautiful health care plan. He supported a Republican bill in Congress that would have dramatically cut Medicaid, eliminated tax credits for healthcare costs, abolished some taxes on high-income earners, and increased the number of uninsured Americans by 23 million over 20 years, according to the nonpartisan Congressional Budget Office. That's the bill that failed with the dramatic “no” vote by Sen. John McCain. So, Trump did not deliver.
He argues that he needs to cut safety-net programs to help pay down federal debt. It has grown by about $3 billion during his presidency, including $1.5 trillion added by the 2017 Republican tax cuts. Republicans rationalized that tax cuts for corporations would trickle down to create middle-class jobs, but corporations used $1 trillion for stock buybacks. The richest fifth of Americans received nearly two-thirds of the tax bill’s benefits, while the richest 1% will receive 83% of the bill’s tax benefits by 2027, according to the Tax Policy Center.
So, middle- and low-income families can’t count on significantly higher pay or lower taxes to buy health insurance or cover out-of-pocket expenses.
Joe Biden can brag about the Obama Administration’s success in breaking a decades-long stalemate and getting the Affordable Care Act passed into law. Recent polls show that the ACA is more popular than in any previous election cycle with 55% of Americans supporting it. Biden would gradually expand the ACA’s coverage for Americans without private insurance.
From the moment Obamacare became law in 2010, Republicans in Congress have chipped away at it and Trump has used his administrative tools to undermine the law so he could prove his claim that Obamacare is a failure. But the ACA reduced the number of uninsured Americans by nearly half. Before it took effect, 46.5 million “nonelderly” Americans were uninsured. After it became law, the number of uninsured fell to 25.6 million in 2017. By 2018 under Trump, America’s insured increased to 27.5 million. Now Obamacare is threatened by a lawsuit that alleges it is unconstitutional in its entirety. The Trump Justice Department supports the lawsuit and the Supreme Court is expected to rule on it this fall.
Meantime, Americans without coverage or access to free tests must pay as much as $1,000 to find out if they have the virus. TIME magazine cites a case where a woman was misdiagnosed and visited an emergency room several times before tests confirmed she had COVID-19. Her medical bills totaled nearly $35,000. CNBC reported that a 10-day hospitalization, not unusual for COVID-19 patients on ventilators, would cost at least $75,000. The $2 trillion assistance package approved last week contains $100 billion for hospitals and health-care providers, mostly to help compensate them for revenues they’ve lost by canceling elective surgeries. But the law reportedly does not help coronavirus patients pay their medical bills.
Then there's the problem that the United States is one of the only developed countries where employers are not required to provide paid sick leave. About a quarter of working Americans do not have that benefit.
Issue No. 2 in this election year should be another looming crisis for which Republicans are deliberately leaving America unprepared: global climate change. We should be doing what Europe is: Targeting coronavirus aid in ways that accelerate the transition to clean energy. For example, if the government helps carbon-intensive industries – aviation, auto manufacturing, and even oil and gas production – the industries should agree to specific reductions in their carbon footprints or the footprints of their products.
Climate change is already threatening the stability of America’s health-care system in ways similar to COVID-19. Renee Salas teaches emergency medicine at the Harvard Medical School and co-authored a report published last fall in the New England Journal of Medicine. “The climate crisis is impacting not only health for our patients but the way we deliver care and our ability to do our jobs,” she says. “And that’s happening today.”
The co-director of Harvard’s Center for Climate, Health and the Global Environment, Aaron Bernstein, says “There’s evidence that extreme weather events are affecting critical medical supplies so we can’t do things as we normally would do because IV fluids aren’t available.”
Climate change and its adverse impacts are accelerating more rapidly than scientists predicted. Yet a federal response has been mocked, blocked and ignored throughout Trump's first term and for many years by Republicans in Congress. Congress has not acted on a climate bill since 2009, and that effort failed. Now Trump has declared his right to distribute $500 billion in corporate bailouts in the coronavirus aid package without congressional oversight – the same kind of contempt for Congress that led to his impeachment. Trump already has complained publicly that his hotels and golf courses are losing money. He has not exactly earned the nation’s trust that he will distribute the money fairly and without conflicts of interest.
Again, neither the pandemic nor climate change is an inherently partisan issue, but Republicans have made them so with their lock-step opposition to meaningful action. Democrats are fully justified in telling voters that these crises will not be addressed until their party controls the White House and both houses of Congress. Otherwise, the federal government will remain gridlocked and powerless to prevent catastrophes before they arrive and to be prepared for those it can’t stop.
There is a lot to talk about in the months ahead, but it's already obvious that the United States needs a sweeping change in leadership in Washington. Some of the reasons are literally matters of life and death.