Coronavirus: Remarks by Donald Trump’s health secretary about cost of vaccine were chilling – Henry McLeish

Donald Trump’s health secretary, Alex Azar, demonstrated the administration’s collective ambivlance towards tens of millions of people when he said there was “no guarantee” a coronavirus vaccine would be “affordable to all Americans”, writes Henry McLeish.
Donald Trump, wearing a ‘keep America great’ cap, holds a picture of the coronavirus (Picture: Jim Watson/AFP via Getty Images)Donald Trump, wearing a ‘keep America great’ cap, holds a picture of the coronavirus (Picture: Jim Watson/AFP via Getty Images)
Donald Trump, wearing a ‘keep America great’ cap, holds a picture of the coronavirus (Picture: Jim Watson/AFP via Getty Images)

When asked about what sort of thing was most likely to blow governments off course, British Prime Minister Harold MacMillan famously replied, “Events, dear boy, events”. The coronavirus is Donald Trump’s event.

On his return from India, the President stepped out of Air Force One, into the eye of a gathering storm, and seemed, at that point, more concerned about the health of the US Stock Exchange rather than the health of the American people. Indeed, after a few Twitter rants from the President, the Federal Reserve has made a dramatic half of one per cent cut in interest rates: to boost his election chances or the economy?

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Since he took office three years ago, Trump has not faced a major crisis, at home or abroad, in the way that Barack Obama had to deal with the 2008 financial crisis, George W Bush was faced with the 9/11 terrorist attack in 2001 or John F Kennedy had to manage the 1962 Cuban missile crisis. Trump’s leadership qualities have still to be tested.

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Six months before polling day, with his re-election hopes riding high on the back of a booming stock market and a growing economy, the last thing Trump needed was a seismic issue to emerge and derail his plans for winning a second term. His insecurity, manic sense of everyone conspiring against him, and his dislike of experts and elites telling the truth, make him an unlikely leader in a crisis.

Amidst mounting criticism, Trump’s administration has struggled to grasp the seriousness of the threat from the coronavirus. At his first press briefing in the White House, he got the number of confirmed cases wrong, said it would be away soon because of the warmer weather, and talked about it in terms of miracles.

Speaking at a rally in South Carolina, and playing to his base, he suggested his political opponents were weaponising the virus as a “new hoax” against his presidency, and fell back on blaming immigrants. And, wildly off the mark, he said that a vaccine would be available soon, when in fact it could take up to 18 months, accofrding to the World Health Organisation. True to form, his idea of leadership and calming the nation was reduced to lashing out at the media and the Democrats and simply lying about the level of threat posed.

Inability to pay

But lack of leadership is only part of this unfolding story. America, despite its massive wealth, doesn’t have a comprehensive or universal health service, free at the point of need, but has instead a poorly coordinated system financed in the main by private health insurance.

Faced with a national emergency such as the coronavirus, America faces a unique set of challenges. In particular, it has a fragmented, confused and underfunded public health system; 28.5 million Americans have no private health insurance; key health institutions have been savagely cut back; and there is a deeply embedded cultural suspicion of government that makes it hard for ordinary people to have confidence and trust in federal and state interventions in health care.

But underpinning all of this is startling revelation that even if vaccines and treatments are available, millions of Americans, who are struggling to pay for health may not be able to afford them or will go broke in the process; a major cause of debt and bankruptcy in America is health and the inability to pay.

Institutions dealing with disease control and health prevention have been ravaged by Trump. Staff have either been removed or have left under duress, expertise has either been sidelined or lost, cuts have been deep and dangerous, senior posts remain unfilled, confidence has been undermined and the overall capacity to operate under emergency conditions has significantly diminished; the reason for the number of cases remaining low in the US is because testing has been so limited compared with other countries. This is a crisis made in the White House.

Humanity reduced to a market place

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Further, complicating matters is the patchwork of funders and providers that make up health provision in the US. Medicaid, operating at federal and state level, helps with medical costs for some people with limited incomes and resources. Medicare is federally funded and provides healthcare coverage for the over-65s and under-65s with disability issues.

Then there is ‘Obamacare’, or the Affordable Care Act, which helps by lowering costs for those who cannot afford them. Millions of Americans have benefitted. The number of uninsured has dropped from nearly 46.5 million in 2010 to 27 million in 2017. This trend has been reversed by Trump with the first rise in a decade. The Republican Party, and the Supreme Court, is trying to kill off the Affordable Care Act.

Health insurance plans, the final and most important piece of this chaotic national coverage, are marketed by private health insurers and serve more than half the population. These plans can be employee-based or individuals can purchase from state or federal market places or private market places. Humanity is reduced to a market place, where people buy the best they can afford, not necessarily what they need.

This makes it nearly impossible to have a coordinated approach to tackle the coronavirus with so many players and different levels of activity.

For many Americans, the biggest danger lurking on the margins of healthcare provision is that they will be unable to afford treatment and will be forced to make life-and-death choices. Many people are ill but don’t seek a remedy because they can’t afford the costs. Others get prescriptions but stretch out their doses and therefore dilute the benefit. Others go into debt from which they may never recover financially, and now people who are being tested for coronavirus have to hope and pray that they don’t have it.

Price of drugs can be fatal

In a chilling reminder of the collective ambivalence towards tens of millions of Americans, Health Secretary Alex Azar, when questioned in the House of Representatives, said: “It’s going to be a long time before a vaccine for the new coronavirus is available. But when it is, there’s no guarantee that it will be affordable to all Americans.”

Azar, a former president of drug company Eli Lilly and pharmaceutical lobbyist, then said: “We can’t control the price because we need the private sector to invest.”

As was pointed out to him, the new coronavirus doesn’t care about profit margins or returns on investment for drug companies. Putting the poor at risk by making it harder for them to access a vaccine, puts everyone at risk.

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A recent Business Insider article highlighted a chronic problem in three crucial areas of health – insulin for diabetes, cancer drugs and heart disease medications – where the crippling price of drugs was literally killing people in the US.

Many Americans worry about their President, but they should also think about health provision in their country, which is making the combatting of the coronavirus much more difficult.

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