Report calls for sweeping structural reforms

The Lancet Commission on Public Policy and Health in the Trump Era issued a report criticizing the health-related policies of the Trump administration, as well as the long-term damage to U.S. health care infrastructure under neoliberal policies.

In their report, the Commission, led by Commission co-chairs Steffie Wollhandler, MD, and David U. Himmelstein, MD, of the School of Urban Public Health at the City University of New York at Hunter College, New York City, accused the Trump administration of politicizing the federal Covid-19 response, dismantling policies aimed at slowing climate change, inciting racial violence, and undermining healthcare coverage.

This is not the first time the Lancet has stepped into the political arena to speak out against former President Trump. For example, in May 2020, Lancet editor Richard Horton—an outspoken critic of the Trump administration and author of the book “The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again,” in which he refers to the former president’s decision to cut WHO funding during the Covid-19 pandemic a “crime against humanity” — and fellow editors released an editorial calling for the U.S. to elect a president “who will understand that public health should not be guided by partisan politics.”

In an editorial accompanying the Commission’s report, David Blumenthal, MD, MPP, President of the Commonwealth Fund, New York City, and brother of Democratic Senator Richard Blumenthal of Connecticut, and Margaret Hamburg, MD, of the Nuclear Threat Initiative in Washington, DC, and former FDA commissioner under President Obama, praised the report for acknowledging the “ideological and systemic causes of U.S. health care problems;” however, they also noted that this analysis “still leaves deep uncertainty about a path forward.”

“The USA is not a health-care outlier by chance, and there have been vigorous reform efforts in the past,” Blumenthal and Hamburg wrote. “Yet reformers face major obstacles. Some of these obstacles are political and cultural, and none are easy to overcome.”

In its report, the Commission laid out a host of accusations against President Trump and his administration:

  • “Politicized and repudiated science, leaving the USA unprepared and exposed to the Covid-19 pandemic.
  • “Eviscerated environmental regulation, hastening global warming.
  • “Incited racial, nativist, and religious hatred, provoking vigilante and police violence.
  • “Denied refuge to migrants fleeing violence and oppression, and abused immigrant detainees.
  • “Undermined health coverage.
  • “Weakened food assistance programs.
  • “Curtailed reproductive rights.
  • “Undermined global cooperation for health, and triggered trade wars.
  • “Shifted resources from social programs to military spending and tax windfalls for corporations and the wealthy.
  • “Subverted democracy both nationally and internationally.”

The Commission also outlined a number of failures in U.S. healthcare infrastructure that it attributed to “damaging neoliberal policies” from both political parties, predating the Trump administration, including a decline in U.S. life expectancy; high mortality among Native Americans and “yawning disparities” between Black and White communities; a rise in substance abuse deaths; widening income and wealth inequality; a rise in incarceration rates spurred by Nixon, Raegan, and Clinton-era drug policies; welfare eligibility restrictions implemented by President Clinton; deindustrialization fueled by placing corporate interests above labor protections; commercialization and bureaucratization of health care; major gaps in insurance coverage among U.S. citizens; and funding cuts that reduced the front-line public health workforce by 20%.

“The suffering and dislocation inflicted by Covid-19 has exposed the frailty of the U.S. social and medical order, and the interconnectedness of society,” the Commission wrote. “A new politics is needed, whose appeal rests on a vision of shared prosperity and a kind society. Health-care workers have much to contribute in formulating and advancing that vision, and our patients, communities, and planet have much to gain from it.”

To help offset this damage to U.S. healthcare, the Commission called on the Biden administration to address “health-damaging structural problems.” Specifically, the Commission called on the current administration to:

  • Raise taxes on high-income people and use the proceeds to bolster social, educational, and health programs, and address urgent environmental problems.
  • Mobilize against the structural racism and police violence that shorten the lives of people of color.
  • Replace means-tested programs such as Medicaid that segregate low-income people, with unified programs such as national health insurance that serve all U.S. residents, aligning the interests of the middle class and the poor in maintaining excellence.
  • Reclaim the U.S. Government’s role in delivering health and social services, and stop channeling public funds through private firms whose profit-seeking skews priorities.
  • Redirect public investments from militarism, corporate subsidies, and distorted medical priorities to domestic and global fairness, environmental protection, and neglected public health and social interventions.
  • Reinvigorate U.S. democracy by reforming campaign financing, reinforcing voting, immigration, and labor rights, and restoring oversight of presidential prerogatives.

While Blumenthal and Hamburg noted that these ideas from the Commission will be useful in addressing U.S. health care problems, they argued that implementing these goals will likely require more direct political involvement on the part of healthcare professionals.

“The hard fact is that the way to health-care reform in the USA requires political activism of the most basic kind, something that is far beyond the comfort zone of many health professionals,” they wrote. “Should that work—by health professionals and others—prove successful… the USA could be repositioned to address the inequalities in income, education, nutrition, housing, justice, and employment opportunities available to Americans, which are often the fundamental roots of our health-care crisis.”

John McKenna, Associate Editor, BreakingMED™

Cat ID: 150

Topic ID: 88,150,730,192,150,151,418,590,925