Joe Biden’s Antietam Opportunity

Joe Biden’s Antietam Opportunity 

By Matt Muchowski

Lincoln read the Emancipation Proclamation to his cabinet.  Painted by F.B. Carpenter. (Library of Congress) (Library of Congress Prints and Photographs Division).

With Covid-19 deaths now daily surpassing the bloodiest days of the American Civil War, Joe Biden should take inspiration from how President Lincoln responded to the bloodiest day of the civil war at Antietam, Maryland.  When he spoke at Gettsyburg last summer, Joe Biden said that President Lincoln, “Re-imagined America itself.”  President Biden should likewise re-imagine America and issue a Right-to-Healthcare Proclamation which would guarantee healthcare coverage to all, address racial disparities, and help fight the coronavirus.

The battle of Antietam took place in September 1862, and was a major turning point in the war.  The first two years of the war were difficult as the Union lost many battles such as Bull Run, and morale for the war in the North sagged.

However General Lee’s invasion of Maryland was repulsed by General McClellan at Antietam, leading to the bloodiest single day of the war, with 4,000 union soldiers killed in one day and a combined total of 22,717 dead, wounded or missing.  The battle had many far reaching consequences.  

The most important consequence of the battle was that it emboldened Lincoln.  5 days after the battle, Lincoln told his cabinet,“I think the time has come now.”

Lincoln used Antietam as a pivot point to re-imagine America by issuing the Emancipation Proclamation which said that as of January 1, 1863, freed slaves in the mutinous states  “shall be then, thenceforward, and forever free.”

Joe Biden comes into office at a similarly historic moment.  Our nation’s 46th President said on Thanksgiving that we are at war with Covid.  The numbers reflect a war.

More than 400,000 dead of Covid-19.  More than 20.6 million confirmed cases.  In July we were at 51 million unemployed.  7.7 million people lost their employer provided health insurance, along with 6.9 million dependents.  That’s in addition to the 29.6 million Americans who were uninsured before the pandemic and the roughly 29% of underinsured Americans, who despite having health insurance, avoid healthcare due to the high costs.

The need for action to win this war is dire. But like Antietam, we are at a turning point, both scientifically and politically.  We have a vaccine, and Donald Trump is defeated.  While we still have much work to do, as Lincoln said, “the time has come now” for President Biden to issue a Right-to-Healthcare Proclamation.

Like the Emancipation Proclamation before it, the Right-to-Healthcare Proclamation would be based in an understanding that racial inequalities are a driving force of the pandemic, and that by taking action to address those inequalities in terms of healthcare, we are making the strategic decisions which will bring an end to this war sooner.

Covid has shown what many of us already knew – that there are deep racial disparities in healthcare in America.  The Pandemic heightened these inequalities, creating an Accute on Chronic Condition by exacerbating a pre-existing condition of lack of investment, healthcare coverage, safety measures and access to affordable medicine.  

The CDC lists a number of health conditions that correlate with an increased risk to Covid – including obesity, heart conditions, and cancer.  These conditions are almost across the board worse in communities of color as a result of decades of inequity.  The CDC says that, “Long-standing inequities in social determinants of health that affect these groups, such as poverty and healthcare access, are interrelated and influence a wide range of health and quality-of-life risks and outcomes.”

These inequalities help explain why more than 33% of Covid-19 deaths are African Americans despite being about 12% of the population, and African American counties have 6 times the death rate as white counties.  Joe Biden’s platform on racial equity was central to his campaign and uses the word “Health” 21 times, highlighting the recipocalness of the wellbeing of communities of color and defeating Covid.  

While President Biden’s $1.9 trillion dollar American Rescue Plan and initial executive orders will be essential to fighting Covid and improving the economy, Biden should use several of the powers afforded to the President in a historic executive order that combines several policies.  At its core, this order would address four issues – use of the Defense Production Act to ramp up production of supplies, expanding healthcare coverage, making workplaces safe, and helping vaccinate the globe.

Joe Biden’s team is already making plans for using the Defense Production Act to compel companies to prioritize production related to fighting Covid.  This will increase access and acceptance of Personal Protective Equipment, testing, and vaccination in at-risk communities.

The Right-to-Healthcare Proclamation should also expand Medicare coverage to the millions without health insurance.  The lack of health insurance coverage in communities of color — for example 10.6% of African-Americans don’t have insurance compared to 5.9% of whites — has played a role in allowing Covid to spread as uninsured people tend to delay treatment.

Medicare could be expanded using what David Dayen called the Libby, Montana model.   Libby, Montana was home to a vermiculite mine, and the airborne asbestos from the mine continues to haunt the 2,628 residents of the town.

As Dayen explained, “As part of the Affordable Care Act, the residents of Libby… were made eligible for Medicare, for free, at the discretion of the Social Security Administration and the Department of Health and Human Services (HHS). It was codified in Section 1881A of the Social Security Act. The language of the statute refers to any individuals subject to an “environmental exposure,””

Libby was a “pilot program,” but President Biden would have the authority to establish other “optional pilot programs” to any area subject to a public health emergency declaration.”  Which is basically the entire county under Covid, although President Biden could do smaller pilot programs focused on the unemployed, uninsured or other qualifying factors.

This Libby model would be similar to the healthcare plan that Joe Biden campaigned on, “Medicare for all who want it.”  Candidate Biden campaigned on providing a ‘Public Option’ which would “give you the choice to purchase a public health insurance option like Medicare.”  This executive expansion of Medicare would not have monthly premiums, but could be combined with a public option.

Such an expansion would need to be coupled with efforts to support the economy.  After all, 1 in 4 Americans has thought about quitting their job over Covid safety concerns and President Biden is working to protect Americans who quit a job over fears of Covid – so they can still collect unemployment checks. 

According to one study – the fear of losing health insurance coverage is a deciding factor for 50% to stay at their job.  When the Affordable Care Act went into effect, the Congressional Budget Office estimated that over a decade, 2.5 million Americans would quit, reduce their hours or stop looking for work, because they could now get healthcare coverage.  While we could argue that these fears limit us from imagining what the economy could be, the urgency of the moment requires us to take action in a way that will bring the biggest buy-in and the least resistance.

Central to reducing job loss due to unsafe workplaces while expanding unemployment and health coverage to the unemployed, is making jobs safe.  A job that OSHA under President Trump has sorely lagged behind on.  As of November, under Trump’s Labor Secretary Eugene Scalia, OSHA has issued only 204 citations out of 10,295 covid-safety complaints, scaled down it’s news releases, given ‘slap on the wrist’ fines for violators, and refused to enact an Emergency Temporary Standard to give employers specific enforceable guidance on stopping the spread of Covid —  all while staffing at OSHA has declined.  This has caused the AFL-CIO, the largest federation of labor unions in the country, to accuse the Trump administration of a “total abdication of its responsibility to act to protect America’s workers.”

Keeping workplaces safe is an issue that has disproportionately impacted communities of color.  Less than 1 in 5 African American workers, and roughly 1 in 6 Hispanic workers can work from home, studies have shown that the risk of workplace exposure to Covid is higher for communities of color and some cities crackdowns on unsafe workplaces have seen a leveling of covid racial disparity.

Increased funding and staffing of OSHA would require Congressional action.  However, President Biden, has already asked OSHA to devise an Emergency Temporary Standard, and should use a Right-to-Healthcare Proclamation to order OSHA to enforce it.

Much like the Emancipation Proclamation helped isolate the confederacy internationally, a Right-to-Healthcare Proclamation should help America lead the world in isolating Covid.

A key part will be renewing America’s engagement with international cooperation by rejoining the World Health Organization and it’s COVAX vaccine initiative – something that President Biden is already committed to.

The Right-to-Healthcare Proclamation should also rededicate the country to USAID’s Global Health Security Agenda and to helping fund foreign aid to counter infectious diseases such as Covid and that increase the risk of Covid, as the Infections Disease Society of America has called for. 

Further, the Right-to-Healthcare Proclamation should instruct the US trade representative to pursue a path of greenlighting generic versions of the Covid-19 vaccines globally.  Covid vaccinations have been administered incredibly unevenly across the globe.  As rich countries have bought up available vaccines and the resources needed to distribute them, it has left many poorer countries without doses, and facing the possibility of it taking years for them to adequately vaccinate.

The US provided an estimated 10 billion dollars in public funds for vaccine development, in addition to funding from other governments around the world.  That’s not counting the years of public investment in the technologies and research needed to produce such a medical marvel.  Yet, drug companies are claiming that the vaccines are their intellectual property to profit off of as they wish — objecting to the World Trade Organization approving generic versions of Covid-19 vaccines.  Talk about socialism for the rich.

Jason Cone, Executive Director of Doctors Without Borders has said that we need, “An R&D system that would benefit us all… If [the government] is serious about bringing down drug prices, the first thing it should do is put access and affordability conditions on the public funding given to medical products in development.”

While such funding conditions might not be able to be applied retroactively without legislative action, the President could work to provide some kind of compensation to drug companies in return for either putting the vaccines in the public domain, or for arranging a low-cost licensing strategy.  Even if such compensation reaches into the billions it would pay for itself as – the International Monetary Fund forecasts that without a more favorable handling of the pandemic, the world nominal GDP would decrease by $80 Trillion, while the World Bank estimates that 150 million people could sink into extreme poverty.

The Emancipation Proclamation was not the end of slavery in America.  However, the Emancipation Proclamation was a deposit towards setting the union on a course towards abolition that culminated in the passage of the 13th amendment, and an important step in the struggle for racial equality which continues today.

Like the Emancipation, this Right-to-Healthcare Proclamation would be the tip of the iceberg in terms of the work that needs to be done.  There is years of work needed to address the health, economic, social, and political fallout from Trump’s incompetent and malicious mismanagement of the coronavirus crisis.

At his inauguration, President Biden quoted President Lincoln’s on signing the Emancipation Proclamation, “if my name ever goes down in history, it’ll be for this act, and my whole soul is in it.” President Biden then continued, “My whole soul is in it today.”

Joe Biden, and the American people, need to ask the question – if this is really a crisis at the same scale as a war, if our whole soul is in this fight – then we need to act like it.  The time for hesitation has passed.  The time has come now — to build back better. 

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