The Health 202: ‘Bidencare’ makes its debut at the final presidential debate

Laveta Brigham

“What I’m going to do is pass Obamacare with a public option,” Biden said. It will “become Bidencare.”  “The Bidencare proposal will, in fact, provide for that affordable health care, lower premiums,” he said a few minutes later. It was the first time Biden has been heard to use the […]

“What I’m going to do is pass Obamacare with a public option,” Biden said. It will “become Bidencare.” 

“The Bidencare proposal will, in fact, provide for that affordable health care, lower premiums,” he said a few minutes later.

It was the first time Biden has been heard to use the term publicly – and striking he chose to use it on the debate stage.

For one thing, the battles over Obamacare – and President Clinton’s “Hillarycare” attempt way before that – have well illustrated the political risks of getting one’s name entangled with a health reform effort. 

The Obama administration eventually embraced the term Obamacare, but it was only after realizing that attempts to quash the name invented by Republicans were fruitless.

Doug Andres, a spokesman for Senate Majority Leader Mitch McConnell:

Biden has spent far more time berating the Trump administration for its pandemic response and unpopular stance on the 2010 health-care law. 

It’s been a relatively easy task, considering Americans are in the midst of a pandemic that has hit their country harder than nearly every other developed nation. The first thirty minutes of the debate – marked by a return to civility compared with the September debate – did feature an extended back and forth between Trump and Biden over what the national response should look like. 

But later on in the evening, the candidates also tangled over a topic that was vigorously debated during the Democratic primaries but virtually ignored in the general election: how to improve the nation’s porous and insufficient health insurance offerings.

Trump insisted that Biden wanted “socialized medicine.” Biden reminded Trump the primary proves he does not. 

Biden’s former opponents Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) – and even, on occasion, Biden’s now-running mate, Sen. Kamala Harris (D-Calif.) – blasted Biden for supporting the system of private health insurance which is still responsible for covering more than half of all Americans.

Biden positioned himself as a moderate on the issue, and stuck fast to it, refusing to back dramatic and sweeping proposals to replace private coverage with a government-run “Medicare-for-all” plan for all Americans. Instead he supports an incremental approach of adding a public option to the marketplaces, which people could choose to purchase.

That didn’t stop the president from trying cast his plan as socialist and falsely claiming it would strip 180 million Americans of their employer-sponsored coverage. “He wants socialized medicine,” Trump said. “Bernie Sanders wants it. The Democrats want it. You’re going to have socialized medicine.”

“He’s very confused,” Biden shot back. “He thinks he’s running against somebody else. I beat all those other people because I disagreed with them.”

“The idea that I want to eliminate private insurance – the reason why I had such a fight with 20 candidates for the nomination – was I support private insurance,” Biden added.

A public option is just one of several proposals Biden’s campaign has laid out on health policy. They include increasing the ACA’s marketplace subsidies, allowing Medicare to directly negotiate with drug companies for lower prices and lowering the age for Medicare eligibility from 65 to 60.

Trump offered a confusing and vague outline of his own efforts to revamp health care.

Congress very publicly failed to repeal and replace Obamacare back in 2017 and his administration has never proposed a comprehensive health-care plan. Yet Trump has never backed away from his promises to pass a law to replace the ACA and repeated them last night without offering any details about what it might involve. 

“I’d like to terminate Obamacare, come up with a brand new beautiful health care,” Trump said. He also promised that pre-existing conditions would be protected, without explaining how. The issue especially critical in the lawsuit against the ACA – which his administration backs and which the Supreme Court will hear one week after the election. 

He struck a similar tune earlier in the day in a “60 Minutes” interview, which he later posted to Twitter in violation of the White House’s agreement with the network. When questioned by Lesley Stahl, Trump insisted – yet again – a health-care plan is still coming, once the outcome of an upcoming Supreme Court hearing on the ACA is known.

“It’s fully developed,” he said, without specifying any details. “It’s going to be announced very soon, when we see what happens with Obamacare.” 

Trump also recited his now-familiar claim that he got rid of the “worst part of Obamacare” by signing a law zeroing out the mandate to buy insurance – and then made the best of an otherwise bad law. But he ended up sounding like he contradicted himself.

“We’ll have Obamacare and it will be better run, but it will no longer be Obamacare,” Trump said.

The candidates also engaged in a lengthy, substantive debate over the pandemic response.

They spent the first half-hour debating the benefits and costs of lockdowns and how the country should respond to the virus over the winter months. Trump offered a black-and-white view of lockdowns – insisting they’re overwhelmingly bad – while Biden laid out a more nuanced viewpoint, insisting “we can walk and chew gum at the same time” by taking precautions that allow businesses and schools to open.

Trump downplayed the ongoing risk of the virus, suggesting that the country was turning a corner. He cited his own recovery from covid-19 and claimed a vaccine will be announced within weeks. While some companies have indicated that they expect interim results from clinical trials this month and could apply for emergency use authorization as soon as November, the vaccine will probably not be widely available for the general public until sometime in 2021 even in a best case scenario. 

Trump also claimed “full responsibility” for the impact of the coronavirus – before quickly casting the blame on China. The quip came in response to an accusation from Biden that the president had failed to take responsibility for the virus.

“I take full responsibility. It’s not my fault that it came here. It’s China’s fault,” the president said.

Trump also oscillated in his statements about Anthony Fauci, stating that he got along well with the nation’s top infectious disease doctor one second and then faulting Fauci the next. During a campaign call with his staff on Monday, the president referred to Fauci and other public health experts as “these idiots.” 

The Post’s Juliet Eilperin:

A core debate revolved around how far the candidates would go in imposing restrictions on businesses and activities in order to quell the virus. Trump predicted Biden would embrace lockdowns and force businesses to shut down, a “cure” he portrayed as “worse than the disease.”

People are losing their jobs, they’re committing suicide, there’s depression, alcohol, drugs at a level that nobody has ever seen before. There’s abuse, tremendous abuse. We have to open our country,” Trump said.

But Biden emphasized giving businesses the support to weather closures, in some cases, or to open safely. 

He skirted around the issue of whether the U.S. might enter another lockdown on the scale of the one experienced in most parts of the country in the spring. Instead Biden suggested that certain businesses like bars and gyms should remain closed if the rate of cases in a community was high. He called for providing schools with more resources, like ventilation systems and smaller teacher to student ratios, to allow them to reopen.

Ramesh Ponnuru, a writer for National Review:

The debate comes as the United States experiences a rise in coronavirus cases. Welker pointed out that 40,000 Americans are currently in the hospital with coronavirus. The United States logged 73,000 coronavirus cases on Thursday, the highest daily count since July, according to a Post analysis.

Perhaps the most encapsulating exchange on the candidates positions was when Trump insisted that “we’re learning to live with [coronavirus]. We have no choice.” 

Biden’s response: “He says that we’re learning to live with it. People are learning to die with it. You folks at home will have an empty chair at the kitchen table this morning. That man or wife going to bed tonight and reaching over … out of habit where their wife or husband was is gone. Learning to live with it? Come on.” 

Ahh, oof and ouch

AHH: The FDA fully approved remdesivir to treat covid-19.

“It had been authorized for use on an emergency basis since spring, and now becomes the first drug to win full Food and Drug Administration approval for treating COVID-19. President Donald Trump received it when he was sickened earlier this month,” the Associated Press’s Marilynn Marchione reports.

The drug, which inhibits a substance that the virus uses to make copies of itself, cut infection time from 15 to 10 days in a study led by the National Institutes of Health. It is marketed by California-based Gilead Sciences Inc. and has been approved or granted emergency authorization in at least 50 countries.

A World Health Organization study last week found the drug didn’t benefit hospitalized patients, contradicting the results of at least three other studies. The WHO study, however, was less rigorous than the NIH study, which included a placebo group. 

The cost of the treatment, has also sparked controversy, running at $2,340 for people with government insurance and $3,120 for patients with private insurance for a typical treatment course.

OOF: Wikipedia and the World Health Organization announced a collaboration to combat misinformation.

“The health agency will grant the online encyclopedia free use of its published information, graphics and videos,” The New York Times’s Donald G. McNeil Jr. reports. “The agreement puts much of the W.H.O.’s material into the Wikimedia ‘commons,’ meaning it can be reproduced or retranslated anywhere, without the need to seek permission — as long as the material is identified as coming from the W.H.O. and a link to the original is included.”

The World Health Organization’s infographics debunking coronavirus misinformation are now available on Wikimedia Commons. Ryan Merkley, the chief of staff for the Wikimedia Foundation, said that the arrangement, if successful, could be extended to combat misinformation regarding AIDS, Ebola, influenza and other diseases. 

False information about the virus can prove deadly. “More than 700 people in Iran were killed by that rumor that you should drink high-grade alcohol,” Andrew Pattison, a digital content manager for the WHO, told the Times.

Pattison said he only has a staff of five. He compared working with Wikipedia’s to “having an army to work with.” More than 82,000 contributors have written or contributed to articles about coronavirus. Two-hundred volunteer editors, many of whom are doctors of academics, work with WikiProject Covid-19 and can review pages if there are suspected errors or malicious changes.

OUCH: A paper claiming the coronavirus was engineered in a Chinese lab was based on shoddy research.

In mid-September, Fox News host Tucker Carlson invited a Chinese virologist on to his show to a new paper that she had published. The paper had the potential to be a bombshell: It claimed to have overwhelming evidence that the coronavirus was engineered in a Chinese lab. The scientist, Li-Meng Yan, claimed that China intentionally unleased the virus on the world.

A month later, public health researchers and CNN, in an investigative expose, have picked apart that claim, exposing sloppy research practices, as well as ties between the researchers and Steve Bannon. Despite pushback, Yan has published a second report titled “SARS-CoV-2 is an Unrestricted Bioweapon.”

Among research flaws that CNN uncovered in Yan’s papers are an unconventional use of pseudonyms without proper disclosure and material seemingly copied from an anonymous blogger. Researchers also flagged flaws in the papers’ citations. “One footnote, for instance, leads to an essay by an entrepreneur that only appears on his LinkedIn page after it was rejected by a scientific journal,” the CNN reporters write.

Fox’s Carlson spoke with Yan again in a later October 6 interview. This time he added a disclaimer, saying “ we are not endorsing your findings.” But Carlson did not disclose Bannon’s involvement with the research.

The Post’s media critic Erik Wemple weighed in with an op-ed on Thursday scouring Carlson for inviting Yan to his program a second time “even though he’d already conceded he lacks the chops to vet her work.”

Race for a vaccine

An FDA advisory group seemed reassured the guidance on approving coronavirus vaccines is rigorous enough.

The meetings of the Vaccines and Related Biological Products Advisory Committee, an outside group of experts convened to provide advice to the FDA, generated a robust online audience who viewed a stream of the meeting live from the FDA’s website, USA Today’s Elizabeth Weise reports. 

“The committee did not vote on a specific vaccine Thursday but discussed FDA’s guidance and requirements to seek either a license or an emergency use authorization for one,” Weise reports. 

Committee members and health regulators face a difficult task: they want to get as much information on the effectiveness and safety of a vaccine as possible, but at the same time are deeply aware that every day 700 Americans are dying of the virus.

The FDA’s guidelines for vaccine approval seemed to assuage the concerns of some committee members. Paul Offit, a committee member and director of the Vaccine Education Center, said that he was “reassured” by the meeting and that the emergency use authorization process outlined by the FDA was “much much much closer” to a full licensing process than he had thought.

The advisory committee and federal regulators are attempting to shore up public trust in a vaccine. That call was echoed by a coalition of pharmaceutical organizations and health insurance companies who released a set of core principles on Thursday advocating for a transparent and organized vaccine approval and distribution process.

Elsewhere in healthcare

The United States signed an international declaration challenging the right to abortion.

“The United States joined Brazil, Egypt, Hungary, Indonesia and Uganda on Thursday to co-sponsor a nonbinding international antiabortion declaration, in a rebuke of United Nations human rights bodies that have sought to protect abortion access,” The Post’s Miriam Berger reports.

Secretary of State Mike Pompeo said the Geneva Consensus Declaration, “defends the unborn and reiterates the vital importance of the family,” during a virtual signing ceremony.

“The Geneva Consensus formalizes a coalition united in opposition to the United Nations’ Universal Declaration of Human Rights, which forms the basis for the characterization of abortion and same-sex marriage as human rights under international law — a position that key U.S. allies, such as Britain and France, support,” Miriam writes.

The declaration is not legally binding, but it follows a series of moves by the United States to use international diplomacy to lobby against abortion.

In 2017 Trump reinstated a policy banning U.S. foreign assistance to health care providers who discuss abortion. The policy, however, has resulted in broad cuts to family planning services and contraception, which may have actually resulted in an increase in abortions, according to a study published in the Lancet last year.

Sugar rush

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