We can quickly identify at least four major reforms that need to be implemented:
1. Every American must have access to affordable healthcare at all times. No exceptions. As Bernie Sanders says (and I am no Bernie supporter): “Healthcare is a human right.” This means, at a minimum, that we need to provide an affordable public option to supplement the private insurance model that has served employed people and their families reasonably well for years. It is unconscionable that, during this health crisis, the Trump administration continues to pursue its court case seeking to terminate the Affordable Care Act (Obamacare) and take away health coverage for 48 million Americans, removing their protection from pre-existing condition coverage denials and throwing their children off their insurance coverage long before the current age 26 mandate. The next Congress needs to enact “Medicare for all who want it” immediately upon convening.
2. The connection between employment and health insurance must be severed. The Health Insurance Portability and Accountability act of 1996 was supposed to accomplish this, but did not. Neither did Obamacare. The 158 million Americans who get their health coverage through their employer must be permitted to take their health coverage with them if they lose their jobs. They, and people who are not working, must be automatically enrolled in a public option plan while unemployed. No one should ever be without health coverage.
3. The Strategic National Stockpile (SNS) must always be fully funded and fully stocked. The Stockpile is the public health emergency equivalent of the National Defense Stockpile. Its purpose is simple and straightforward: rapid deployment (within 12 hours) to resupply overwhelmed local medical supplies during any public health threat. It has failed to achieve this, falling woefully short in the current pandemic. In 2009, the H1N1 influenza pandemic triggered the largest deployment in SNS history when 12.5 million antiviral regimens were deployed across the country as well as 19.6 million pieces of personal protective equipment (PPE) and 85.1 million N95 respirators. Since 2017, the Trump administration allowed the number of ventilators to plummet to only 16,600 (or 2½ per U.S. hospital)! The SNS must be stocked with more than enough PPE—masks, ventilators, scrubs, gloves, etc.—so that we are never caught short again when a pandemic strikes. And it is a certainty that, in an increasingly complex and intertwined world, there will be more pandemics.
Since assuming office, the Trump administration has undermined the SNS by: (1) moving responsibility for it—and what should be included in it—from the non-political Centers for Disease Control and Prevention (CDC) to a political appointee in the Department of Health & Human Services. This was a license to politicize what products the government purchases for the SNS. Pharmaceutical firms began to lobby heavily for their products in lieu of the prior approach where only CDC medical experts made purchasing decisions; and (2) attempting, year-after-year, to slash the SNS budget despite its already being underfunded. So far, Congress has managed to stave off these cuts, but at the cost of being unable to increase funding for SNS supplies deemed essential to combatting a pandemic.
4. International cooperation to combat public health emergencies is a must. “America First” in this context means “America Worst.” The U.S. should take the lead in crafting an international treaty committing the nations of the world to work together to plan ahead, to combat future pandemics and to coordinate supply chains of essential materials so that they can be produced and shipped wherever needed. In the absence of such an agreement today, a German startup is currently trying to coordinate the production of PPE around the world by 3-D printing firms that have volunteered to aid in the battle against COVID-19. Viruses do not give a damn about borders. Neither should politicians.
March 27, 2020