18. He doesn’t care if 20 million Americans die

America’s healthcare system is a mess. Ours is the only First World nation where lots of people routinely sicken and die because they cannot afford medical care. The reasons behind the mess are too numerous, and many of them too complex, to be discussed here. Suffice it to say that for decades various corporate interests, most notably the insurance and pharmaceutical industries, have wielded an inordinate amount of control over where and how the money funding Americans’ healthcare flows. Government efforts at intervention over the years—Medicaid and Medicare, for instance—have improved the situation somewhat in terms of giving more people access to care, although this has been at the expense of adding further layers of complexity onto what was already a labyrinth for both patients and providers to negotiate. At the end of the day, the fact remains that about 1 in 8 Americans have no health coverage at all, at least double that number are have insufficient coverage, and still more are at risk insolvency if they happen to get seriously ill or injured.

None of the above is particularly DT’s fault; it has been that way for years, and there is ample blame to go around. What is DT’s fault can be stated quite simply:

• he promised to repeal Obamacare and replace it with something better;
• he has failed to keep his promise thus far;
• if he is reelected, he almost certainly will keep his promise to repeal Obamacare;
• he has no plans to replace it with anything else.

Obamacare, more formally known as the Affordable Care Act or ACA, was passed by Congress and signed into law by President Obama in 2010. It constituted the first major attempt by the U.S. government in decades to address the inadequacies of the American healthcare system. Far from a panacea, Obamacare is deeply flawed: among its deficiencies is the fact that coverage is prohibitively expensive for many of its potential enrollees. A single-payer system, such as the misleadingly named Medicare for All plan proposed by some Democrats, would fix that, but the political will to enact such a system is hard to come by. So we’re stuck with Obamacare.

For all of its shortcomings, Obamacare has brought health coverage to 20 million Americans who didn’t have it before and allowed many others to afford better coverage than they had previously. It also forbids private insurers from denying coverage to people with preexisting conditions or making their coverage more expensive. Most importantly, it provides a proven framework to which improvements could be added, bringing near-universal coverage to Americans at long last.

DT and his toadies on Capitol Hill want to end all that, and with the pending installation of Amy Coney Barrett to the Supreme Court, they are likely to get their wish: oral arguments before the Court on the future of Obamacare are scheduled for November. Despite promising to provide a replacement plan for Obamacare, in four years the White House has failed to come up with one. So if DT is reelected, 20 million Americans will lose their health coverage, millions will be denied new coverage or see their premiums hiked, and the chances of a fair and rational system offering coverage to everyone will go up in smoke. If DT is denied a second term, and especially if the Senate flips to Democratic control, there will be several viable paths not only to restoring Obamacare but to building on it.

Give it a miss, Joe

During his town hall broadcast last night, DT cast doubt as to whether he’d tested negative for Covid-19 on the day of the debate between him and Joe Biden—a prerequisite for participating per the Commission on Presidential Debates. Unless there is credible evidence (perhaps a statement from his physician) that he has tested negative for next Tuesday’s debate, Biden should decline to appear. It is simply not worth the risk of becoming infected. We’ll need you alive and well in January and beyond, Joe.