By Walker Bragman
Jacobin, January 21, 2022
Despite the fact that the vaccines are highly effective at preventing severe infections, hospitalizations, and death from COVID-19, just 36 percent of Americans today are fully vaccinated with a booster and about a quarter have not even gotten a single dose. A poll from September found that more than 80 percent of the unvaccinated did not plan on getting the shots.
The court’s ruling comes at a particularly bad time for the White House. The Omicron variant is surging across the country, bringing with it record-high COVID hospitalizations and case numbers, and new lows for the president’s approval numbers.
Biden has blamed vaccine hesitancy on “dangerous misinformation on cable TV and social media.” But a good deal of the blame lies with his own administration and its failure to do everything in its power to combat that misinformation and make it as easy as possible for people to get vaccinated — such as by trying to establish a national health insurance program like Medicare for All or a public option. Experts say such an effort could have been the best way to turn the tables on the country’s ongoing battle with COVID.
Surveys of the unvaccinated have found that they are more likely to be uninsured and have lower incomes. One study from the Kaiser Family Foundation in June found that uninsured Americans were twice as likely to be unvaccinated.
A national health insurance program would help stem the spread of disinformation that is discouraging some people from getting vaccinated.
“The evidence is clear: When Americans have access to primary care without financial barriers, they are more likely to trust their health providers’ advice and get vaccinated against COVID-19,” said Dr Susan Rogers, an internal medicine physician in Chicago and president of the pro-single-payer group Physicians for a National Health Program. “However, our fragmented health system prevents most Americans from building a trusting relationship with a provider.”
The Role of Primary Care Providers
From a public health perspective, national health insurance makes sense — especially during a pandemic.
A March 2021 report by the progressive group Public Citizen found that hundreds of thousands of US COVID deaths could have been avoided under a single-payer system, noting that under such a system, hospitals would be better funded and providers better able to coordinate care for patients. Americans would stop skipping doctor visits due to cost or lack of insurance. People of color, in particular, the report notes, “would no longer face disproportionately high rates of uninsurance, reducing an important contributor to racial disparities in access to health care.”
There is another benefit to having national health insurance that could directly impact vaccine rollout: It would increase access to primary care physicians, who have proven to be a vital point of contact in efforts to vaccinate the country.
That’s likely in part because primary care doctors have long been closely associated with vaccinations. A survey published in July in the Annals of Family Medicine found that in 2017, primary care physicians delivered more than half of vaccinations in Medicare Part B Fee-For-Service, including between 25 and 50 percent of vaccinations in the majority of counties.
Biden has indicated he is aware of the role this critical group plays in convincing people to get vaccinated. In September, he called on doctors to reach out to their unvaccinated patients to talk to them about the vaccines.
“Tonight I’m asking each of you to reach out to your unvaccinated patients over the next two weeks and make a personal appeal to them to get the shot,” the president said.
Many Americans, however, do not have a personal doctor to talk to them about such matters. A study published in December 2019 in the Journal of the American Medical Association (JAMA) Internal Medicine revealed that a quarter of all Americans don’t have a primary care provider — and that number was rising.
According to the study, one of the main reasons that fewer and fewer people have a primary care physician is because of health insurance requirements.
“Financial barriers, especially among uninsured Americans, may prevent some people from accessing primary care,” noted the report.
According to Rogers, “Uninsured Americans may go years without seeing a primary care provider due to cost,” while “those with commercial insurance plans face not only high copays and deductibles that discourage regular care, but also constantly changing provider networks that make it nearly impossible to stay with the same primary care physician long term.”
The solution, she says, is a nationalized health insurance option. “A Medicare for All system would guarantee that everybody in the U.S. had access to regular primary care, with full choice of provider and no cost barriers to stand in the way,” she said.
Having access to a trusted medical professional would also go a long way to combatting medical misinformation about COVID vaccines. A November survey from the Kaiser Family Foundation found that 78 percent of American adults — almost eight in ten — either believed or were uncertain about false statements related to the pandemic or the vaccines. The unvaccinated, along with Republicans, were more likely to hold such misconceptions.
Such misinformation is killing people. An NPR survey from December found that counties that voted for Trump in 2020 had lower vaccination rates and higher death rates than those that voted for Biden.
Weekly tracking by Morning Consult reveals that countries with free and/or universal health care have far lower rates of vaccine hesitancy than the United States. Of the countries surveyed, only Russia fared worse.
Biden Abandons Reform
While Biden promised to establish a public insurance option during the 2020 presidential campaign, since he took office, major health care reform has vanished from the national discussion.
Back in April, when the White House released the fact sheet for its $1.8 trillion American Families Plan — the follow-up to the American Rescue Plan Biden signed in March, which the Build Back Better Act was based on — there was a line committing to the goal of establishing a public option. But the policy itself was not included in the bill.
Alex Lawson, the executive director of the progressive group Social Security Works, tells Jacobin that health care reform, outside of expanding the Affordable Care Act and subsidizing more private health insurance plans offered on the ACA marketplace, was never a priority for Biden’s administration — even though it could have made vaccine rollout easier.
“Biden could have anointed somebody in the Senate to carry [the public option] for the White House. It could have been a White House priority for sure,” he said. “But lacking a White House priority, which was sort of obvious to me, at least, the only thing that could have made it happen otherwise is a Senate champion.”
When the White House released its proposed budget in May, it included more private insurance subsidies pushed by industry lobbyists, but funds for a public option were conspicuously absent. Senator Patty Murray (D-WA) and Representative Frank Pallone (D-NJ) pledged to continue fighting for such a bill, but as of earlier this month, the work was still supposedly underway.
At the time Biden released his budget, Lawson told NBC that he thought that a public option was, for the time being, dead. “I don’t think there’s a dynamic where we see it at the center of a political fight again,” he said.
But experts say pushing for these health care reforms could encourage greater vaccine adoption rates — and potentially resuscitate Biden’s dismal poll numbers.
Polling consistently shows high levels of support for a nationalized health insurance program. A Morning Consult survey from last March found that 55 percent of voters supported Medicare for All, with just 32 percent opposed, and 68 percent favored the idea of a public option.
At this point, moving forward on a public option would likely prove all but impossible for a president who has been unable to deliver on his major agenda items. Such a push would put Biden not just on a collision course not only with conservative Senators Joe Manchin (D-WV) and Kyrsten Sinema (D-AZ), but also highly profitable corporate health care interests with limitless cash.
Shortly after Biden took office, the health care industry set to work to prevent any major reform to the current system. One group that was particularly aggressive was Partnership for America’s Health Care Future (PAHCF), a front group for health insurers, pharmaceutical companies, and hospital chains.
PAHCF ran ads claiming that a public option would mean “higher costs, and fewer options for Americans,” while deceptively arguing that any changes to the US health care system would harm communities of color — even though they disproportionately experience barriers to care and worse health outcomes under the current private health insurance-based system.
Public option proposals at the state level, meanwhile, have also come up against stiff opposition. When Washington state passed its public option plan in 2019, hospitals lobbied for and secured a loophole allowing them to not accept the insurance. PAHCF has a state-focused affiliate that has fought state public option proposals in Colorado, Nevada, and Connecticut.
“The majority of Americans — and their physicians — support an equitable and publicly financed national health system called Medicare for All,” Rogers says. “Unfortunately, those who profit most from our broken system, namely commercial insurance and pharmaceutical companies, have billions to spend on lobbying, political donations and fear-mongering ad campaigns. Medicare for All advocates must organize in every community so that our voices and our votes are more powerful than the lobbying might of health care profiteers.”
