The human cost of political retribution as policy during a public health crisis

Much of the presidency of Donald Trump has been marked by his systematic dismantling, or attempted dismantling of the work of President Barack Obama.

Trump rose to to right-wing prominence starting in 2011 by repeatedly leveling racist, false accusations that Obama was a Kenyan-born Islamic usurper. The trajectory of this line of attack eventually won Trump the presidency as the Republican brand broke to his will and became warped into his image.

The Trump Administration then set out to roll back every possible portion of the Obama legacy, seemingly with no regard to the policy consequences and their impacts on millions of American lives.

While we’ve seen this in policy areas from the environment to worker safety, nowhere has this policy of political vengeance been more disastrous or painful for everyday people than the attacks on access to health care and health care policy at large.

Most famously, Trump failed to fulfill his campaign promise of repealing the Affordable Care Act after the iconic thumbs-down from the late Republican U.S. Sen. John McCain of Arizona.

But an analysis in October from the health policy nonprofit Kaiser Family Foundation estimated that “almost 54 million people — or 27% of all adults under 65 — have preexisting health conditions that would likely have made them uninsurable in the individual markets that existed in most states before the Affordable Care Act.”

So apparently Trump’s political vengeance against Obama was worth the price of 54 million Americans losing access to health insurance. Thankfully, he was unable to execute this rollback.

This past week, we see that in the middle of the worst pandemic of a century, Trump is pushing forward with his plan to scrap an Obama-era policy that protected LGBTQ patients from discrimination.

From Politico’s Dan Diamond:

The health department is close to finalizing its long-developing rewrite of Obamacare’s Section 1557 provision, which barred health care discrimination based on sex and gender identity. The administration’s final rule on Thursday was circulated at DOJ, a step toward publicly releasing the regulation in the coming days, said two people with knowledge of the pending rule. The White House on Friday morning also updated a regulatory dashboard to indicate that the rule was under review. Advocates fear that it would allow hospitals and health workers to more easily discriminate against patients based on their gender or sexual orientation.

The necessity of attacking access to health care for a marginalized community in the middle of a pandemic is lost on me, but this is far from Trump’s most disastrous decision in his Rollback Obama ethos.

For that, we go to a story first reported by Politico’s Dan Diamond and Nahal Toosi and subsequently picked up by others that the Obama Administration had spent years developing a 69-page playbook for how to respond to a pandemic, and when this pandemic hit, the Trump Administration threw it to the side.

“Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”

The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.

The U.S. Department of Health said that the Trump coronavirus response has instead been based on “more recent plans such as the foundation of the National Biodefense Strategy (2018), Biological Incident Annex (2017),and panCAP (2018) among other key plans provided by the CDC, White House Task Force, FEMA, and other key federal departments and agencies.”

If so, then those plans have all lagged in timeline and failed in cohesiveness compared to what was set out in the pandemic playbook that was developed over the course of seven years.

All manner of negative consequences have followed, and the current lack of federal leadership is on full display every day as states have scrambled to obtain supplies, often in competition with one another, and coordinate a response.

Trump’s obsession with undoing the work of Obama sometimes only has narrow consequences. What’s so deeply unsettling however, is that no matter what’s at stake, no matter how many lives are on the line, no matter the value of the actual policy or playbook itself, Trump repeatedly chooses political payback over the health and safety of the American people.