Election 2020: the ‘Healthcare’ Question

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by Jane M. Orient, M.D.

Americans’ top concern in the election is their ability to get medical care when they are sick or injured. The top candidates’ differences are stark.        

President Trump is for choice—and also quality and cost. Without choice, people are stuck with whatever the system permits at whatever price it sets.

With Trump’s America First Healthcare Plan, Americans have control over how their money is spent, and their physicians can personalize their treatment.

With the Biden Plan, Americans’ money goes into a central pot, and the top decisionmakers determine available therapy, to optimize population health (not yours).

President Trump’s record has been to open as many options as possible under the rigid restrictions of the [Un]Affordable Care Act (ACA). He removed the individual mandate of ACA, which imposed a penalty/tax on Americans unable to afford the costly plans satisfying ACA’s many requirements. He has eased counterproductive federal regulations that impede patient care and increase costs. He also pushed for “right to try” legislation. He understands the “pre-existing conditions” problem, and promises to protect those who are affected—without destroying the insurance system.

With COVID-19, Trump imposed international travel restrictions at a time when Democrats objected. He directed resources including ventilators to hard-hit areas, and dispatched a Navy hospital ship that turned out to be unnecessary. He encouraged the rapid production of personal protective equipment (PPE) and ventilators—responding to the pre-existing problems of failure to replace the stockpiles depleted in the influenza epidemic of 2009 (when Biden was in office) and of outsourcing our production capacity, largely to China. He recognizes the strategic need to bring industry home, especially production of essential drugs.

Trump allowed federalism to work for public health measures, instead of issuing dictatorial decrees from Washington, D.C. Some states did better than others. Downstate New York, ruled by Gov. Andrew Cuomo and Mayor Bill DeBlasio, have virtually the worst mortality statistics in the world, and a crushed economy besides. Gov. Cuomo’s alleged disregard of CDC guidelines and forcing nursing homes to admit COVID-infected patients may have contributed. Excluding downstate New York, the U.S. did better than most of Europe.

Trump mentioned hydroxychloroquine (HCQ) favorably, leading to a storm of partisan negativism about a previously noncontroversial, well-established drug. A similar storm happened in Brazil, when President Jair Bolsonaro not only mentioned the drug but took it very publicly himself when infected with COVID-19. He recovered quickly.

Following a negative pronouncement by the Food and Drug Administration (FDA), most states placed restrictions on use of HCQ for COVID-19, although FDA acknowledges that it places no constraints on “off-label” uses of approved drugs.

Joe Biden and Kamala Harris haven’t been in a position to determine health policy, so they are running on promises. They deplore the possibility that the Supreme Court might find ACA unconstitutional. But they themselves may eventually get rid of ACA (and choice and private insurance plans). The Biden-Sanders Unity Task Force would revive the “public option” rejected in ACA. This would deliberately rig health insurance markets to guarantee that the new government health plan gets advantages denied to private health plans, paving the way to single payer. Confusingly, in the Trump-Biden debate, Biden said: “I’m not going to listen to him. The fact of the matter is I beat Bernie Sanders.”

As for COVID-19, Biden blames U.S. mortality on President Trump. “It is what it is because you are who you are,” he said in the debate. In June, he said, “If I’m elected, I’ll immediately reach out to Dr. Fauci and ask him to continue his incredible service to our country.” Dr. Anthony Fauci has been very negative about early COVID-19 treatment as “unproved,” and Biden has called Trump “totally irresponsible” for taking HCQ for a time until last May.

At age 80, Dr. Fauci himself may not be in his position much longer, but he exemplifies the mindset of federal bureaucracies. He was in charge early in the AIDS epidemic. In 1987, when patients were dying of pneumocystis pneumonia, activists pleaded with Dr. Fauci to issue guidance that suggested prophylactic treatment with Bactrim, a safe sulfa drug, based on studies done in transplant patients in 1977. Dr. Fauci refused, insisting on the “gold standard” of randomized controlled trials (RCTs). Since the National Institutes of Health refused to fund trials, activists raised the money themselves. By the time the results were ready, 2 years later, 17,000 patients had died needlessly. Since efforts to develop an HIV/AIDS vaccine have so far failed, the standard of care is now pre-exposure and post-exposure prophylaxis (PrEP and PEP).

In a 2020 re-play with COVID-19, Dr. Fauci disregards the experience of thousands of physicians who treat patients worldwide, demanding RCTs. About 100,000 patients may die because of lack of early treatment or prophylaxis.

In the COVID-19 crisis, Americans are seeing the effects of authoritarian rule over medicine, with censorship and outright suppression of personalized treatment, while centralized bureaucracies decide what is best for us.

On Nov 3, will America choose freedom?