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Calls Grow for Medicare for All; Uninsured & Communities of Color Hurt Most by End of COVID-19 Funds

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With COVID-19 coverage ending for the uninsured, we look at how uninsured people and communities of color will bear the impact of the end to free COVID-19 testing, treatment and vaccines, and how the pandemic has led to a renewed push for Medicare for All. We are joined by Dr. Oni Blackstock, primary care and HIV physician and founder and executive director of Health Justice, and Dr. Adam Gaffney, critical care physician, professor at Harvard Medical School and immediate past president of Physicians for a National Health Program.

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now!, The War and Peace Report. I’m Amy Goodman, with Nermeen Shaikh.

As cities across the United States lift mask mandates and researchers track an uptick, the Omicron subvariant BA.2, we spend the rest of the hour looking at who will bear the impact of cuts to funding for COVID-19 relief, as the pandemic leads to a renewed push for Medicare for All. Earlier this month, Congress passed a massive spending bill that stripped out nearly $16 billion in COVID-19 funding to cover free COVID-19 testing, treatment and vaccines for the uninsured. As of last week, major testing companies started asking the uninsured to pay up to $195 for PCR tests. The CDC estimates some 31 million Americans had no insurance in the first half of 2021.

This comes as a new report on “The State of Black America and COVID-19” by the Black Coalition Against COVID, the Yale School of Medicine and the Morehouse School of Medicine warned Black Americans face higher rates of COVID and are more likely to face serious illness or death as a result of disinvestment in healthcare in Black communities. The report also found racial disparities in the diagnosis and treatment of long COVID.

On Tuesday, the House Oversight Committee held its first hearing on Medicare for All since the start of the pandemic, led in part by progressive Democratic Congressmember Cori Bush, who is a nurse, who said, quote, “Americans deserve a healthcare system that guarantees health and medical services to all.” Speakers included the lawyer and healthcare activist Ady Barkan, who was diagnosed with terminal ALS. He testified from his home using a computerized system that tracks his eye movements and turns them into spoken words.

ADY BARKAN: It’s shameful that in the richest country in the world, we choose to inflict so much suffering. Since that first hearing about Medicare for All, our country has been through the worst public health crisis in a century. The pandemic has revealed and exacerbated the existing inequalities in our profit-driven healthcare system. It has hit hardest on disabled people, poor people, Black, Latino and Indigenous people, and especially people who live at the intersections of these categories. And one out of three COVID-19 deaths in the U.S. are related to gaps in health insurance. Nearly a million Americans have already died from the coronavirus. How much more is necessary to shock our legislators into action?

When we lost 3,000 lives on September 11th, we responded by reorganizing our national security system, launching a global war on terror and conducting two massive invasions and occupations. Three hundred times more people have died in this pandemic, but we have not marshaled our national energy to build a better healthcare system. It is a scandal, and it is a shame.

AMY GOODMAN: For more, we’re joined by two guests. In Boston, Dr. Adam Gaffney is with us, critical care physician, professor at Harvard Medical School, immediate past president of Physicians for a National Health Program. He co-authored a study published last month in the Journal of General Internal Medicine that showed uninsured people in the United States are more likely to be infected with COVID-19. And in New York, Dr. Oni Blackstock, primary care and HIV physician, founder and executive director of Health Justice.

We welcome you both back to Democracy Now! Dr. Adam Gaffney, let me begin with you. You just wrote a piece, “Covid-19 Coverage for the Uninsured Is Ending.” So, we are talking about if you want to get tested and you’re uninsured and you can’t afford it, you can’t get a test. At the same time, people are unmasking. Lay out the scenario here. And is this, do you feel, going to lead to a further surge? Is there already a surge in certain communities?

DR. ADAM GAFFNEY: Well, I think the impact of withdrawing support for treatment, testing and vaccination for uninsured individuals is going to be a disaster. Look, when this pandemic started, there was an awareness that our healthcare system was not going to perform well with 30 million uninsured, with far more underinsured. To control a pandemic, you need people to be tested so they know to isolate. And now we have good therapies, as well, that need to be started early. So, by taking away access to testing and treatment to uninsured individuals, who could now face soaring medical bills, were they to present to a hospital needing medical care, you are certainly going to deter the use of that care. And I am very worried about the impact on that population, which is already disadvantaged and already at higher risk of COVID.

NERMEEN SHAIKH: And, Dr. Gaffney, this is happening in a moment when, despite the fact that vaccines have been available, easily accessible and free for over a year in the U.S., the percentage of Americans who are fully vaccinated is just 65%, and the percentage who are boosted is substantially lower, at 44%. So, could you talk about this cut in funding when, really, vaccination rates are relatively low?

DR. ADAM GAFFNEY: Well, that’s precisely the issue. We should be doing more in our pandemic response, particularly as the BA.2 subvariant of Omicron may be causing a new wave in coming weeks. So that’s exactly right: We should be improving access to vaccines, we should be doing more outreach of boosters, we should be doing more to ensure people have access to therapeutics, that must be started within several days of symptom onset to be effective, rather than moving in the other direction. Effectively, what we’re seeing happen now is we are making — we are treating COVID as just another illness, which means high costs and people going without it because they can’t afford it. And that’s unacceptable, and it’s a public health — it makes zero sense from a public health perspective.

AMY GOODMAN: Let me bring in Dr. Oni Blackstock, primary care and HIV physician, just finished this major report on the state of the health of Black America. If you can talk about the impact of this COVID-19 funding being cut at this point — again, I want to reiterate, at a point when everyone is taking off their masks — what it means when you have an unprecedented support of the largest military budget in U.S. history, and yet cutting back on COVID, and particularly what it means for Black America?

DR. ONI BLACKSTOCK: Yes, this is going to have a disproportionate impact on Black people and other people of color. We know that among people who are uninsured, Black and Latino people, in particular, are disproportionately represented. And so, we saw that with the availability of free tests, vaccines and treatments — we actually saw, over the course of the pandemic, inequities in death rates actually narrow. So, while Black and Latino people and Indigenous people are still at increased risk in terms of exposure and more likely to become infected, availability of vaccines have helped to actually narrow the gap when it comes to COVID-19 deaths.

However, if we now have the end of this federal program that provided free tests and vaccines and treatment for the uninsured, we’re now going to see more challenges, for instance. Let’s say the second booster, for instance, is now being recommended. Those individuals who may not have the flexibility to take off from work to go get a booster or to find a location are going to have challenges. And so we’re going to see likely widening disparities, inequities in these COVID-19 outcomes with this funding for the uninsured program having run out. And then, eventually, it will actually impact the general population.

NERMEEN SHAIKH: Dr. Blackstock, could you talk about the key findings of this report, “The State of Black America and COVID-19: A Two-Year Assessment”?

DR. ONI BLACKSTOCK: Sure. So, the report really laid out the last two years of the pandemic and the pandemic’s disproportionate impact on Black Americans in terms of Black Americans being at increased risks for exposure because of the occupational segregation that has really left us in many frontline jobs as essential workers, so we’re more at risk for exposure, and very little has been done in terms of workplace protections, and also speaking to the disproportionate impact in terms of hospitalizations and deaths, because we are more likely to have, for instance, underlying conditions, which again is the result of lack of access to quality care, the impact of sort of the everyday toll of racism, the wear and tear on our bodies, otherwise known as weathering, which also increases risk of underlying conditions and leads to more serious outcomes with COVID.

We also see that Black people, because of our increased risk to exposure to COVID, you know, the impact of long COVID is likely to be greater on our community. However, there is a lack of data being collected and a lack of analysis really looking at how are we being impacted by long COVID. We know that earlier in the pandemic it was very challenging to get COVID testing, for instance. We do have reports and studies showing that Black and Latino people, in particular, were turned away from testing. And often people need a test as proof that they’ve had COVID in order to get treatment for long COVID, although that has been discouraged and that just saying that you have COVID should be sufficient. But we are still trying to collect the data that we need to see the extent of these inequities, and there definitely needs to be much more focus on ensuring Black communities have the support that is needed to protect themselves from COVID.


NERMEEN SHAIKH: Dr. Blackstock —

AMY GOODMAN: Go ahead, Nermeen.

NERMEEN SHAIKH: Go ahead, Amy. Dr. Blackstock, people have been comparing HIV and COVID. You, of course, are an HIV physician, and you’ve said a more accurate comparison would be between long COVID and HIV. Could you explain?

DR. ONI BLACKSTOCK: Right. So, you know, COVID, obviously, acutely people will have an infection, an active infection, and then that typically passes. But we know 10% to 30% of people who do have COVID end up having long COVID, which is a chronic condition. HIV, as well, is a chronic medical condition and requires ongoing access to care, to treatment. And so, you know, we spoke to these issues around the uninsured. We know that Black people, in particular, are overrepresented among the uninsured. And so, some of the same challenges we see in terms of access to treatment and prevention when it comes to HIV, we are also seeing when it comes to COVID, as well.

AMY GOODMAN: I wanted to go back to Dr. Adam Gaffney. Last night I was actually speaking to Congressmember Nikema Williams about Black maternal mortality and the issue of Medicare for All. And you had this major hearing where we just heard the activist Ady Barkan, who has ALS. He said one out of three COVID-19 deaths in the U.S. are related to gaps in health insurance. I wanted you to respond to that, and Public Citizen saying you’ve got the defense budget, $813 billion. “By comparison, the White House has asked for just $5 billion to fight global COVID,” and more than $22 billion to fight COVID in total. “That’s roughly three percent” of military spending “to help end a pandemic that has taken more American lives than any war, and nearly twenty million lives worldwide so far.” If you could comment on this and how it all pushes for, as you see it, Medicare for All?

DR. ADAM GAFFNEY: Well, absolutely. Look, the fact is, we do need federal coverage for the uninsured for COVID. And that should be done urgently. But that is a Band-Aid, a needed Band-Aid, but really the problem is far broader. We need universal healthcare so that people have all medical conditions covered, so that people, regardless of whether it’s COVID or another infection or another chronic illness, do not need to worry about going bankrupt because they need to see a doctor or go to the hospital.

I think the other point here is that this is a virus that is not going away, OK? And so, simply another stopgap, while important, is not a substitute for real universal reform so that this can be taken care of indefinitely.

Finally, the point you made about underfunding our pandemic response is exactly correct. Look, we went into this pandemic underfunding public health agencies. We need to be expanding our public health infrastructure to tackle not only the pandemic of the present but the pandemics of the future, to say nothing of the other health threats that face us in the years to come, like the impact of climate change and much more. So, we should be expanding our public health infrastructure. We should be moving to a universal Medicare for All system to take care everyone regardless of illness. And we should be doing those things right now, even as we’re creating those stopgaps to deal with the deficiencies in our current system.

NERMEEN SHAIKH: Dr. Gaffney, could you also say, quickly, what do you think can be done to increase vaccination rates in the U.S.?

DR. ADAM GAFFNEY: Well, I think an important point of comparison is the United Kingdom, that has much higher rates of boosters, right? And that tells you something, because most people who have already been fully vaccinated presumably aren’t totally vaccine hesitant, and the fact that they haven’t been boosted suggests that part of the problem is the medical care system, that we are not doing sufficient outreach directly to people at high risk of severe outcomes if they have COVID. So, I think that there’s a lot we can do creatively in terms of pushing out vaccinations. People have talked about door-to-door campaigns, workplace clinics, school clinics and much more. But I think part of the problem does fall back on a fragmented and privatized healthcare system that has not performed at the level of, for instance, the United Kingdom’s National Health Service in actually getting vaccines into arms and getting boosters into arms, among a population that we know is at least willing to have some vaccinations. So I think there’s a few things that can be done. But I think the important thing is that more can be done, more has to be done, and we shouldn’t tacitly accept unnecessary deaths from COVID and assume that there’s nothing that can be done.

AMY GOODMAN: Let me end asking Dr. Oni Blackstock about what you think is the most important issue right now when it comes to COVID-19 and the Black community.

DR. ONI BLACKSTOCK: Yes, I think there are a number, I think, of issues; however, there needs to be really, I think, you know, as the discussion is saying, a sort of increased focus on ensuring that people have access to the care that they need — that’s one — but also protections. We know that support for mask mandates and other types of safety measures are higher in the Black community compared to the white community. We actually saw this study released yesterday showing that the more that white Americans hear about racial inequities, the less likely they are actually to support COVID-19 safety measures. So, actually, we’re seeing these sort of opposing forces, even though the reality is that we are all interconnected and that if the Black community has access to care, to safety measures, that actually is something that can protect all of us. So we need to actually just increase our support for access to prevention and treatment for COVID.

AMY GOODMAN: Thank you so much for being with us, Dr. Oni Blackstock with Health Justice and Dr. Adam Gaffney at Harvard Medical School. I’m Amy Goodman, with Nermeen Shaikh.

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