Today, Explained - The Trump Years: Health of the nation

Episode Date: October 29, 2020

In the fourth of our five-part series, Vox’s Dylan Scott explains how a president with no plan on health care evolved into a president with no plan for the pandemic. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit connectsontario.ca. Please raise your right hand and repeat after me. I, Donald John Trump, do solemnly swear. I, Donald John Trump, do solemnly swear. That I will faithfully execute. That I will faithfully execute. The office of President of the United States the office of President of the United States and will, to the best of my ability and will, to the best of my ability preserve, protect and defend the Constitution of the United States So help Constitution of the United States. So help me God.

So help me God. Congratulations, Mr. President. It's Today Explained. I'm Sean Ramos-Ferrum. Four years ago, Donald Trump from reality TV won the presidency, and our shared reality hasn't been the same since. The relentless pace of headlines, controversies, and tweets has rendered the country divided at present and unable to fully recollect the past. I've seen the tweet about tapes. Lordy, I hope there are tapes.

We struggled to remember what this president said or did last month, let alone in 2017. For the past few weeks, we've been helping you remember with our series on the Trump years. We've been looking back on Donald Trump's policies, accomplishments, and scandals during his four years as president to figure out what they mean for the future of the American political experiment. On today's show, the health of our nation. From before he was president to this very minute, Donald Trump has been talking about health care. Not necessarily a vision, but undoing the vision of his predecessor. And then, of course, in his fourth year, he was hit with the biggest challenge of his presidency,

a global pandemic that continues to set the worst kinds of records in the United States. Today, we're going to look at these two essential health stories with Dylan Scott, who has covered both for Vox. Dylan, let's start with President Trump's obsession with undoing Obamacare, which he seemingly remembered is one of his obsessions lately. What I would like to do is a much better health care, much better. It's like TBT with President T. So I'd like to terminate Obamacare, come up with a brand new beautiful health care.

He's been saying he has a plan again. Does he have a plan, Dylan? No, he doesn't have a plan. We're four years into the Trump presidency, and there is still no comprehensive Trump health care plan. But he still really hates that other one by his predecessor. One of the worst things anybody's ever had to live through. We got rid of the individual mandate. Yes, he is still promising that he can repeal Obamacare and deliver better, cheaper health care to Americans. But I think Trump's problem on health care is that he's never actually been able to come up with a plan to meet those promises and neither have congressional Republicans. Let's go all the way back to candidate Trump for a second. What were

his health care promises when he was running against Hillary Clinton? So I think Trump was making three big promises on health care. One of my first acts as president will be to repeal and replace disastrous Obamacare. He was promising to repeal and replace the Affordable Care Act, as Republicans had been doing for years. He was promising that he would be pro-life, anti-abortion, you know, pursue regulations and appoint judges who would advance that agenda.

I've become pro-life. I was in a meek fashion pro-choice, but I've become pro-life. And he was promising that he would bring down drug prices. So we buy drugs, biggest in the world, and we pay about $300 billion more than we're supposed to if we negotiated the price. So there's $300 billion on day one we saw. That was one of his big populist talking points, trying to talk to pocketbook issues that voters really care about. Well, let's go through those in reverse order, starting with at least what sounds like maybe the easiest of the three, just reducing drug costs. How did he do on that?

The president's agenda has taken a couple of different tacks. For one, he certainly has sent out a fair number of threatening tweets. Drug prices will soon be lowered massively. Big pharma, drug companies, are advertising against me like crazy because lower prices mean less profit. When you watch a fake ad, just think lower drug prices. The looming specter of more aggressive federal regulation might encourage pharma to keep drug prices down on their own, but that's not much of a policy agenda, obviously. The most interesting thing that the administration has proposed would be using international drug prices to set the prices that Medicare would pay for medications. Basically,

you would take Germany and maybe the UK and Canada, other rich, developed countries, check the price that they pay for a given medication, and then the Medicare would refuse to pay anything higher than that. And so that's an idea that even like Bernie Sanders has sounded receptive to over the years. It's certainly an example of Trump promoting and supporting policies that are sort of unorthodox for a Republican. This is much more of a democratic, progressive idea. But they haven't actually finalized the regulation. The administration first floated this idea

very early on in the administration, and they released a draft proposal. But the federal rulemaking process is very complicated. There's a few different steps that you have to take for regulation to actually be finalized and in effect. And the Trump administration hasn't taken those steps yet. And they actually, I think, being cognizant of that shortcoming, President Trump signed an executive order just a few weeks ago saying that

this was a policy that he supported. Therefore, today I'm signing four sweeping executive orders that will lead to massive reduction in drug costs, massive. But all the policy experts and health law scholars were saying at the time that this executive order doesn't have any effect. You still have to go through the process of writing and finalizing federal regulations, and they haven't done it. The Trump administration has been talking about putting together these $200 discount cards that they would send out to Medicare beneficiaries, you know, maybe with the president's signature written across them. These cards are incredible. The cards will be mailed out in coming weeks. I will always take

care of our wonderful senior citizens. Joe Biden won't be doing this. They've been trying to finagle some way to make this legally permissible, pretend it's some kind of demonstration project to test whether drug costs will be lower for people if they get effectively a gift card from the government. But I think the subtext of all of that is a recognition on the Trump administration's part that they have not really delivered on this promise. And we see that in a few different ways. The fact that they haven't finalized regulations, the fact that prices are still going up, and the fact that

they're making these kind of last desperate attempts to try to get something done on the issue just before the election. Okay, so promise one, prescription drug prices would go down. Lots of talk, lots of tweets, an executive order, but he didn't really deliver. Let's move to promise two, that the Trump administration will be didn't really deliver. Let's move to promise two, that the Trump administration will be anti-abortion. More success there? I would say that is something that Trump has really focused on delivering on. I've just come from the Rose Garden of the White House, where I proudly nominated Judge Amy Coney Barrett to the United States Supreme Court. Evangelical Christians are a very important part of his base.

This is an issue that they really care about. Life is a core tenant of who we are as Americans. And this election is a choice between two radical anti-life activists and the most pro-life president we have ever had. And so I do think there has been a concerted effort by the administration to fulfill some of those promises. So, you know, the federal judges and the Supreme Court justices that Trump has appointed are generally more pro life anti-abortion, certainly more so than any judges and justices who would have been appointed by a Democratic candidate. And this is another area where they actually have followed through on regulations. Early on in the

administration, Trump's health department proposed allowing employers from Fortune 500 companies to non-profit Catholic organizations, they would be allowed to refuse to cover contraception if they so chose for any religious or moral reason. And that regulation, as all are on contentious issues, was the subject of a lawsuit. That lawsuit actually worked its way to the Supreme Court over the summer. The justices on the Supreme Court have sided with the Trump administration, allowing employers to opt out of Obamacare's birth control mandate. The impact is immediate. The government estimates between 70,000 and 126,000 women

will lose their contraception coverage under this rule. Which, you know, was a win both for Trump's anti-abortion agenda and for his efforts to focus on the judiciary and put more conservative justices on the bench. Yeah, this is definitely one where I think Trump has had a real focus and has actually been able to deliver for his supporters. And that contraception mandate Trump rolled back was one small part of Obamacare, which brings us to his third promise we talked about at the top, get rid of Obamacare. He's been obsessed with that from the jump.

Absolutely. I mean, President Trump came into office and the first item on Congress's agenda was repealing and replacing Obamacare. One of the Senate's very first acts as Congress was to pass the legislative tools necessary to repeal Obamacare. We did so because the American people who had suffered for years under the failures of Obamacare were calling out for relief. Remind us how that went. It didn't go well.

It was a failure. It ended up sucking up almost all of the Republicans' time and attention during their first year with full control of Washington, which is such like a pivotal period. That's when you have a chance to really get things done before

concerns about re-election and just sort of the inertia of Washington, D.C. takes over. And they really did try. You know, you might remember House Republicans initially failed to come together on a plan back in March of 2017. Yeah, I don't know what else to say other than Obamacare is the law of the land. It's going to remain the law of the land until it's replaced. We did not have quite the votes to replace this law. And so, yeah, we're going to be living with Obamacare for the foreseeable future. I don't know how long it's going to take us to replace this law. Then they worked on it for a couple months, finally managed to pass something later that spring. And then Senate Republicans spent the next few months trying to figure out their own repeal and replace plan.

They weren't able to come up with one to get 50 votes. Obviously, John McCain's big thumbs down will always be a defining moment of the Trump presidency. Seven years of repeal efforts have now essentially gone up in smoke, leaving a frustrated McConnell to explain on the floor. And even all the way through September of 2017, so almost that entire first year, Senate Republicans were still trying to figure out a plan that could get 50 votes in the Senate, and they weren't able to do it. And I think that reflects a couple of things. One is, you know, Trump made a lot of big promises on what his health care plan would do. He would say things like, everybody's got to be covered. This is an un-Republican thing for me to say,

because a lot of times they say, no, no, the lower 25%, they can't afford private. And he promised that it would bring costs down for everybody. Those are two really hard promises to make, because in order to cover everybody, you have to be willing to cover people who have really expensive medical conditions. And that makes it really hard to bring down costs for everybody. So those two goals are kind of in tension. And Republicans, the reason they found themselves in a pickle, I think, is because in the end, the Affordable Care Act is a pretty conservative health policy. Is that why it's so hard for the president to come up with an alternative plan? Because Obamacare wasn't a public option and wasn't private insurance, but instead something in between.

And that's kind of the only other thing you can do. There's certainly some tweaks you can make to Obamacare to try to make it more conservative, a little less heavily regulated. And there are some conservatives who have proposed ideas to do that. But yes, fundamentally, Obamacare is a pretty conservative healthcare plan on its own. And if you are promising to repeal it from a more conservative viewpoint, it's really hard to continue guaranteeing coverage for everybody and making sure pre-existing conditions are covered, and making sure health insurance is affordable without doing more of Obamacare rather than less. And so I think that's why you've seen President Trump has been reduced to signing completely symbolic, legally toothless executive orders that say things like, it is the policy of the United States for pre-existing conditions to

be covered. The irony of that is that it is already the policy of the United States for pre-existing conditions to be covered. The irony of that is that it is already the policy of the United States for pre-existing conditions to be covered because Obamacare is federal policy. All told, I mean, four years of attacks on Obamacare coming after what was already some pretty heavy Republican opposition. What effect has it had on this health plan? The uninsured rate has started to tick up under Trump. They've taken some small regulatory actions to try to undermine the Obamacare markets, cutting advertising, trying to allow for non-ACA coverage to be more available to people, and other things like Medicaid work requirements,

though those have been caught up at the courts. So we have seen several million more people become uninsured under Donald Trump even before coronavirus and the unemployment crisis that has led to more people losing coverage. So I certainly don't want to lose sight of those material effects that have already happened under Trump's watch. But I think the most significant thing that Trump has done was he and congressional Republicans repealed the individual mandate penalty as part of their tax legislation that passed at the end of 2017. That was kind of the one thing that everybody could agree on. The mandate had always been unpopular and Republicans had always, you know, kind of cited that more than anything else as the reason that Obamacare is such an affront to what they think of as American

values. But the scary thing, and almost the irony of their repealing the mandate, is that that has now become the basis for a Supreme Court case that could end up invalidating Obamacare in its entirety and leading to, you know, 20 million people losing health coverage if Congress and the White House aren't able to come up with a plan to replace it and prevent that from happening. So we're talking about potentially 20 million people losing health coverage. And this is where Trump's failure to come up with a health care plan is so worrisome because he and the Justice Department are asking the Supreme Court to overturn Obamacare next spring. And they still haven't come up with a plan to replace it if that were to happen.

And as I know, I don't need to tell you, but I will, this would be happening in the middle of a global infectious disease pandemic that has already killed more than 200,000 Americans and more than a million people worldwide. And we are facing the very real possibility that millions of people who are going to potentially need treatment, who are potentially going to need a vaccine, you know, people who've had long-term symptoms who are going to be dealing with health problems for a long time, millions of people could wind up uninsured while they're trying to confront those problems. More with Dylan in a minute. It's Today Explained. Thank you. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained, ramp.com slash explained, r-a-m-p.com slash explained. Cards issued by Sutton Bank, member FDIC, terms and conditions apply. BetMGM.com for terms and conditions.

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BetMGM operates pursuant to an operating agreement with iGaming Ontario. Dylan, we've been talking about the coronavirus since January of this year on the show, but I feel like we know a lot more now than we did back then about how exactly the president handled this. What do we know from the very outset now? So we know that even before anyone had heard of coronavirus, before it had ever found its way to humans, the Trump White House actually dismantled a pandemic response office

that had been set up inside of the White House. So that was sort of the first thing. You know, public health has long been underfunded and undersupported in the United States, but the Trump White House took some very specific steps that made the U.S. less prepared when COVID-19 came to our shores. But beyond that, we obviously know, you know, from the Bob Woodward interview, and really we've known it for the duration, that the Trump White House did not want to take a strong leadership role on COVID.

Which he said back in February that it's deadly, it's deadlier than the flu. It's also more deadly than your, you know, even your strenuous flus. Very much emphasized with numbers that it's more deadly than the flu. You know, this is 5% versus 1% and less than 1%. And now today, he says, This is a flu. This is like a flu.

There's been since been a report from the New York Times that found as far back as April, you know, which was really still the worst of the outbreak in the New York City area. The Trump administration was trying to send as much responsibility down to the states. The states should have been building their stockpiles. For them to handle, you know, getting protective equipment, increasing their hospital capacity, coming up with plans to test and trace people. They wanted to slough off as much of that responsibility as possible to the states and take much more of a backseat role. We're a backup. We're not an ordering clerk. We're a backup. And you've had, you know, some people have now tried to start assessing how different countries handled COVID-19. Foreign Policy Magazine put together a global response index here in the last couple of months. And they

rate the U.S. very poorly on both how well prepared we were for a pandemic and now how we've responded to it now that we're in the middle of one. And I think a lot of that can be attributed to the Trump administration failure to both proactively come up with a plan in advance and then to develop one once the crisis was here. We talked about this pandemic response office being eliminated early on in this pandemic, but it's kind of amazing with the Woodward revelations to know that the Trump administration knew they didn't really have a dedicated team on this kind of thing. And they knew this was airborne, and they knew this was going to be lethal, and they still didn't really do very much. Yeah, it seems that they treated this much more

as a political problem. You know, the risk, I guess, of being really proactive and being seen as the one who's responsible for getting COVID-19 under control, is that you could fail and you could end up looking like a fool, which obviously President Trump in the middle of a re-election year, that would be the last thing that he would want. And so that's what seems to have motivated this whole idea that, you know, this is really up to the states. And we're just here kind of monitoring things from Washington, D.C. I mean, you heard Jared Kushner, the president's advisor and son-in-law,

he said early on that... The notion of the federal stockpile was it's supposed to be our stockpile. It's not supposed to be state stockpiles that they then use. So we're encouraging the states to make sure that they're assessing the needs, they're getting the data from their local situations, and then trying to fill it with the supplies that we've given them. The federal government plays a very important role in coordinating across states and providing more funding to support state and local health departments. Because the state and local

governments are the front line for any public health emergency. They're the ones who are on the ground. They need support and they need an engaged federal government coordinating different supplies, coordinating strategies across the states and cities because an infectious disease like COVID doesn't care about borders. It doesn't care if you're in North Dakota or South Dakota. It's going to spread wherever it can spread. And so you really do need a strong national leadership.

The things that that can do is allocate testing supplies across the country, depending on which places are experiencing the worst outbreaks at a given time. I know over the summer from talking to health workers on the ground that when Florida was in the worst of their COVID outbreak, it was taking a week or more for test results to come back. We have this huge problem here. Tracing is a problem. Testing is a problem. Our hospitals are getting full capacity right now. Actually, we just had a case right now in our city where one of the funeral homes had to bring in a trailer, a freezer, because of so many people that are passing away. But at the same time, one of the health workers I talked to knew somebody up in Connecticut where actually COVID had kind of subsided after the worst of it in the spring. And they were able to get test results in a day or two, which actually would be useful

for the people down in Florida. So I think in both their roles, both trying to come up with a national strategy and providing the kind of resources that only the federal government can, the Trump administration really has fallen short. The administration is trying to spin some of its COVID response in a positive light at the debates at the RNC. Trump likes to compare himself to Biden and say that Biden came out and said that the, you know, China travel ban was xenophobic, where Trump seems to feel like he's been validated in doing that. He likes to paint the WHO as in cahoots with China. There is some evidence that the WHO dropped the ball here. Did the administration take some measures that helped?

So I think something like banning travel from China did make sense. You know, this is an infectious disease that can take several days for symptoms to show up. Like if you can limit people from moving around the world and spreading it unknowingly, you know, that's going to help tamp down on transmission and maybe give a little bit of time for us to get prepared. But I think there were a couple of problems. One is that banning travel from China does not actually stop anybody from China from actually making their way to the U.S. You know, they could fly through Europe. of problems. One is that banning travel from China does not actually stop anybody from China from actually making their way to the U.S. You know, they could fly through Europe. And so we've had,

I think, reports of some number of people who did end up coming from China to the U.S. during that period after the travel ban had been instituted. And of course, once they got here, there was no contact tracing. Right. We had no contact tracing. We didn't have any kind of infrastructure to keep track of those people and figure out, yeah, who they might be exposing to COVID. On top of that, you know, like, the president also likes to talk about banning travel from Europe. That example also shows some of the pitfalls of a borders-focused strategy, I guess, which is that when he issued that order,

we suddenly had this surge of people trying to get back home from the U.S. Pandemic panic at some of the nation's biggest airports as new travel restrictions caused long lines to clear customs for people returning from Europe. The hours-long wait times in Dallas, New York, and Chicago, packing huge crowds into tight spaces, exactly the kind of gathering Americans are being told to avoid. We will probably never know how many of those folks, you know, coming from Italy or Spain were already infected and brought the virus to the U.S. and helped to seed outbreaks here as well. So travel bans have some value, but they're certainly not an end to themselves. And maybe the best way to think about this is that banning travel can buy you time, but you have to take advantage of the time that they had bought with the travel vans

and instead quite the opposite, as we said. And now we've seen the consequences of that failure all these months later. As we inch closer to this election, cases are climbing again across the United States. Plus the holidays are coming. Plus flu season is coming. Plus winter is coming.

More time indoors. Is the president focused at all on what could happen in the next months with this virus while he is surely focusing a heck of a lot on the election? No. In fact, he seems to be in denial.

The fake news media loves to say cases are up. The fact is we've done a very, very good job. Cases are up. We have done. That's right, because we're doing so much testing. I mean, it's clear at this point, as you say, we're entering a third wave of COVID here in the U.S. What's scary about this one is that it seems to be happening everywhere. It's not just isolated to one region or to one state. COVID cases in 43 states and D.C. are up at least 10 percent in the last two weeks, including record numbers in Illinois, which has topped 9,500 deaths.

And yet the president is saying things like, It will go away. And as I say, we're rounding the turn. We're rounding the corner. It's going away. He continues to disparage Dr. Anthony Fauci and other government scientists, public health experts. People are tired of hearing Fauci and all these idiots, these people, these people that have gotten it wrong. Fauci's a nice guy. He's been here for 500 years. Every time he goes on television, there's always a bomb, but there's a bigger bomb if you fire him. And so it's really not great altogether. It doesn't seem like the president sees any problem with how he's handled COVID thus far, and there doesn't seem to be any reason to expect a change from his administration in the coming months. Not to mention if he wins re-election. Not to mention if he wins re-election. No, there's not been any sign of a pivot except a pivot away from paying

any attention to COVID. There was a moment there where it seemed like Donald Trump had the opportunity to really unite the country in the fight against this virus. I mean, it just, it didn't feel like in those early days that anyone was out there cheering for him to bungle this entire thing. If anything, there was just a lot of confusion out there and people wanted reassurance. And it just feels like such a shame that he didn't see this as a way to maybe even get reelected, right? Like Jacinda Ardern just like won re-election with a whopping plurality. Right. It's very easy to imagine an alternate universe where, yeah, President Trump sees the coronavirus as perverse as it might sound as an opportunity. He ran as a candidate saying that I alone can fix America's problems. And here was,

you know, the biggest problem that we faced during his four years in office. And in my mind anyway, I can at least imagine that somebody like Trump would be like, you know, now I get to do stuff. I get to order people around. I get to direct supplies to be distributed across the country. I can mobilize the military. There's all kinds of stuff you get to do as the president

when there's a pandemic and a national emergency that requires a national response. And we have certainly seen a lot of other national leaders around the world enjoy a surge in popularity because of how they've handled COVID-19. And now we've seen the opposite effect for him in that he is obviously struggling in his reelection campaign, and his handling of the COVID-19 response is very unpopular with the American public. So I remain as perplexed as you are. And the only real explanation that I can offer is, and it goes back to the same issue he encountered with Obamacare, which is that it requires a plan to respond to a pandemic. It requires that kind of engagement and an active interest.

And the president has never really shown an affinity for those finer details of public to a pandemic. It requires that kind of engagement and an active interest. And, you know, the president has never really shown an affinity for those finer details of public policy. And I think we've seen the consequences of that during the last year. Dylan Scott, he reports on health care at Vox. He's also been covering the heck out of this pandemic. Find all his reporting at Vox.com. And while you're there, you can find all the previous episodes in our series on the Trump years. They're at Vox.com slash Trump years. We'll wrap up our series tomorrow with Rebecca Traitster from New York Magazine and Ezra Klein from Vox, the website.

And now, the ones we lost along the way. Steve Bannon. Let them call you racist. Wear it as a badge of honor. Fired. Dina Powell. Resigned. Rick Dearborn. Resigned. Sebastian Gorka. They want to take your pickup truck. They want to rebuild your home. They want to take away your hamburgers. This is what Stalin dreamt about but never achieved. Fired.

Jeremy Katz. Resigned. George Sifakis. Resigned. Anthony Scaramucci. What happens to leakers on your watch? They're going to get fired. Fired.

Tom Price. Resigned. Keith Schiller, resigned. Carl Icahn, resigned. Ezra Cohen-Watnick, fired. George Jijicos, resigned. Rents Priebus. You know, we heard from the pool reporter there, they were headed to the same car, they got in the same car in the motorcade,

and then it became clear as the news broke that Reince's car was no longer in the same car in the motorcade. And then it became clear as the news broke that Reince's car was no longer going to be in the presidential motorcade. And then, according to the pool report, Scavino and another aide leave, go into a car that is returning to the White House with the president. And Reince Priebus alone heads off in a different direction. Maybe heading home. That's pretty amazing, don't you think, Mark? Fired. Thank you.