While the world faces one of the greatest threats in the history of humankind in the form of the COVID-19 pandemic, the United States seems to be the worst-hit. It has the highest number of reported cases, with casualties crossing the 97,000 mark. President Donald Trump has unequivocally blamed China for exporting the virus to the world and his homeland. He also lashed out at the World Health Organization (WHO) for its negligence in containing the spread of the virus during its initial days. As a disciplinary measure, his administration has decided to freeze US funding to the organization for the time being. Whatever be the reason behind the novel coronavirus transmission, the reality is that American citizens are losing their lives at a very frightening rate. Like all other nations, an ongoing marathon is occurring among the various health and research agencies in the US to develop a vaccine for this disease. For example, the National Institute of Health and various biopharmaceutical companies are going all out to solve this threat to humanity. However, the Trump administration has not just to deal with the COVID-19 pandemic, it also has to handle the grave problems that have been underlying the US healthcare system for decades. The intensity of transmission of the Coronavirus disease increased because of the already existing lacuna in the health sector.
The United States spends about 17% of its GDP on the healthcare sector. The average per capita expenditure on healthcare in the US is $10,580, which is the highest in the world and almost twice that of most of the advanced nations. Despite this fact, in terms of access, quality, and costs, the US ranks much lower than other advanced nations. The performance of the US in major health indicators such as life expectancy at birth, infant mortality rate, and quality of primary care has not been very appreciative. The skyrocketing prices of medical services, consultation charges of physicians, and administrative costs make healthcare unaffordable for medium and low-income citizens. Affordability is a major issue in the country; even with the best medical services in the world, there has been a tendency among Americans to delay their access for these services unless there is a dire illness. Consequently, people in the early days of the outbreak were hesitant to get tested for COVID-19.
Ever since the Great Depression in the 1930s, various administrations have tried to achieve universal health insurance coverage. However, welfare programs have always been contentious in the domestic politics of the United States. The 1965 Medicare and Medicaid program was the first major national healthcare reform that provided health insurance to vulnerable groups such as the elderly, women and children. It was followed by the People’s Protection and Affordable Care Act, commonly known as Obamacare, which sought universal coverage by including that part of the population that was still uninsured.
Interestingly, this March, the ACA completed ten years since it was passed in 2010. Since the act was voted solely by the Democrats in both the House of Representatives and the Senate, not even a single Republican supported the bill. Repealing Obamacare was one of the main agendas of Donald Trump’s campaign in 2016. After coming into power, attempts were made to replace ACA by proposing the Association Health Plans (AHPs), which were cheaper, short-term, and excluded pre-existing conditions (the very opposite of Obamacare). Despite various efforts by the Trump administration, Obamacare could not be repealed in the Senate. In 2018, in fact, a considerable number of Americans re-enrolled to Obamacare.
With the declaration of COVID-19 as a national emergency, the administration, with the support of Congress, released a relief package of $50 billion to deal with the crisis. Later, through bipartisan legislation called the CARES Act (Coronavirus Aid, Relief, and Economic Security Act), a $2 trillion stimulus was provided to financially support the healthcare providers and also to help uninsured Americans gain access to the tests and treatment of COVID-19.
Despite all these measures, the cases in the US continues to grow, along with the deaths due to coronavirus. A number of polls indicate that many Americans are disappointed with the government’s way of handling the situation because of the delay in recognizing the COVID-19 problem and responding to it. Furthermore, people are not happy with the public statements of the President and inaccurate pieces of information that they have been receiving from his end.
Legislation like the CARES Act and its relief packages are fundamentally different from the entire healthcare policy of the Trump administration that seeks to reduce government’s involvement in the health sector. The need for such acts to help the citizens to get access to healthcare in a public health emergency like COVID-19 reinforces the logic behind Obamacare.
As 2020 is also a year of Presidential elections in the United States, this will be one of the most contentious issues in the national debates. Democratic candidate Joe Biden, the former Vice-President, has been championing President Obama’s cause to reform the US healthcare system. His healthcare plan aims to be “building on Obamacare” by spending $750 billion more for the same by increasing federal subsidies. His plan aims for a Medicare-based public insurance option for employers with small businesses and also for the individuals at a subsidized rate. This plan gives another option for accessing health insurance even if one loses one’s job as the insurance system in the United States is primarily employer-based.
He is also campaigning along the lines of enhancing credibility and effectiveness and eliminating the cost barriers for testing and medical care in dealing with the COVID-19 situation. Although the substance of these claims by Trump’s opponent needs to be assessed, it will certainly influence the public opinion especially when chaos and uncertainty caused by this pandemic are highest.
Nevertheless, whosoever comes to power in 2021, it will be crucial for the next administration to introspect the structural flaws in the US healthcare system and make amends to fix them. This would help in augmenting the quality and access of the medical service while reducing the costs. However, before that, there is an urgent need for the Trump administration to control the coronavirus outbreak, provide more resources to the healthcare providers, and, most importantly, to develop a vaccine for the cure of COVID-19 through collaboration with international research agencies so that thousands of lives can be saved.
*** The author is a PhD scholar at the Centre for Canadian, US & Latin American Studies, School of International Studies, Jawaharlal Nehru University ***