Trump Pivots From Health Insurance to Health Itself
For the first time in a long time, the American president devoted more attention in his State of the Union address to talking about health—as distinct from health insurance.
Skipping past the losing war over repealing Obamacare, President Trump’s two boldest declarations on health concerned AIDS and pediatric cancer. Both elicited big cheers. Of course they did, because curing disease is popular.
From a policy point of view, Trump was most specific on HIV/AIDS, saying that he wanted to end the spread of the disease within a decade.
The battle against AIDS has been an epic saga, of course, on many levels. Yet perhaps most of all, it’s been a testament to the power of concerted scientific and political action to curb a killer disease. And that should be a lesson to all of us, as we think about applying the same template of success to other devastating illnesses.
It’s startling to recall that just four decades ago, AIDS didn’t have an agreed-upon theory of causation. There wasn’t even a standardized name for it. And in the ’80s, of course, a diagnosis of AIDS was usually a death sentence.
Then came improvements in treatment, and still more improvements. According to the CDC, since 1990, the U.S. death rate from AIDS has fallen by more than 80 percent.
To be sure, the fight has been expensive. Federal spending on AIDS research has averaged a little less than $3 billion a year, and there’s been plenty of other money aimed at research. In addition, overall spending on AIDS-related care has amounted to hundreds of billions of dollars. (In effect, AIDS care has been an anticipatory microcosm of national health insurance.)
And yet, all humanitarian considerations aside, measured purely in dollars-and-cents terms, winning the fight against AIDS has been worth it. That is, helping people stay out of the intensive care unit, and even returning them to the taxpaying workforce, has proven to be economically remunerative. In 2016, economist Tomas Philipson estimated that thanks to better AIDS health, gains to the economy over the previous quarter-century have totaled a trillion dollars. (Notably, Philipson now serves as a member of President Trump’s White House Council of Economic Advisers.)
As for pediatric cancer, Trump was more anecdotal. Citing the case of Grace Eline, a 10-year-old cancer survivor from New Jersey, he pledged an additional $500 million for cancer research.
We have, of course, been fighting “the emperor of all maladies” for a long time. Back in 1971, President Richard Nixon used his State of the Union to declare a “war on cancer.” As he said then, “I hope in the years ahead we will look back on this action today as the most significant action taken during my administration.” Nixon’s plan was instantly popular: even in a Democratic-controlled Congress, it passed later that year by a wide margin, and Nixon, of course, was re-elected in a landslide the following year. (Cancer was hardly the top issue in 1972, but every little bit helps.)
Still, in the political imagination, the “war on cancer” is widely remembered as a disappointment, even a failure—although, of course, much of that has to do with the backlash against Nixon himself.
It is true that today, according to the American Cancer Society, the disease is still rampant: 1.7 million Americans were diagnosed with cancer last year, and more than 600,000 died of it. Yet the death rate from cancer fell by 22 percent from 1975 to 2015, and Nixon’s war on cancer had a lot to do with it.
Indeed, there’s a strong connection between the success against AIDS and the progress against cancer. Doctor Robert Gallo, co-discoverer of the AIDS virus back in the ’80s and now director of the Institute of Human Virology at the University of Maryland, got his start as a cancer researcher. He freely credits the surge in cancer spending as a boon to his future research on AIDS.
So we can see: progress is not always fast, but it can be made. (Indeed, we would do well to remember that not all wars are over quickly. There was, for instance, a Thirty Years’ War, an Eighty Years’ War, and even a Hundred Years’ War—which actually lasted 116 years.)
Trump had still more to say about health and medicine. He cited “right to try” legislation, a libertarian idea that enables patients to experiment with more medicines. Trump had been pushing for this since coming into office; he signed it into law in May.
Meanwhile, what Trump didn’t talk much about was health insurance. As we all know, the health issue that has consumed the most political oxygen over the last quarter-century has been the issue of national health insurance. Back in 1993, the Clinton administration pushed what became known as “Hillarycare,” and it proved to be so unpopular that not only did it fail, in the following year’s midterm elections, the Democrats lost both the House and the Senate.
Then in 2009, the Obama administration revived the idea; the Affordable Care Act was inevitably dubbed “Obamacare.” And yet, not unlike the Clintonians, the Obamans soon discovered that while the idea of national health insurance is broadly popular, the specific legislation is not—at least not at first.
In 2010, the Democrats pushed Obamacare through Congress on a near-party line vote—whereupon Republicans won big in the 2010 and 2014 midterms.
Next it was the GOP’s turn to take on the health insurance issue. In 2017, the Republicans, now joined by Trump in the White House, tried mightily to repeal Obamacare. And for their trouble, they were walloped in the 2018 midterms, with health insurance being the single biggest issue of concern for voters.
The lesson seems clear enough: any change to the status quo on health insurance is not going to sit well, at least at first. That is, health insurance is a complicated category concerning unpleasant matters, and so people don’t wish to think about it. So the fact that politicians in both parties have chosen to keep raising it can be seen as the triumph of ivory tower ideology over street-smart pragmatism.
One might conclude that a modestly Bismarckian national health plan, fully mindful of the need to avoid such hot buttons as abortion, sex-change operations, and “death panels,” would be sustainably popular. And yet for whatever reason, neither party has chosen to embrace such a centrist solution.
In the meantime, both parties are demonstrably better off focusing on cures—as Trump did on Tuesday night. Yes, national health insurance is important to people, but medical cures are more important. After all, when you go to the doctor concerned over a lump or a pain, the driving issue isn’t health insurance but rather health. Yet with the conspicuous exception of AIDS, from Clintoncare to Obamacare, the fight has always been over health insurance, with health itself an afterthought.
To illustrate the differential between health insurance and health, we can recall not only the Nixon cancer legislation, but also the one big attempt to focus on cures over the last couple of decades, namely the 21st Century Cures Act, which President Obama signed into law on December 13, 2016. That legislation, spearheaded by Senator Roger Wicker and Congressman Fred Upton, was a comprehensive package of medical funding and regulatory reform. It even included a new EUREKA Prize for research on Alzheimer’s Disease, likely the most dreaded illness in America today.
Yet what’s perhaps most interesting about the Wicker-Upton bill is the irenic politics of it. Even in divided and rancorous times, the 21st Century Cures Act received overwhelming bipartisan support: the vote in the House was 392-26, and in the Senate, 94-5.
Admittedly, today, the “name ID” for the 21st Century Cures Act is low. Precisely because it was so uncontroversially popular, the legislation sailed into law—and then sailed into obscurity.
Nevertheless, the idea of cures, as well as the politics of cures, doesn’t have to be hazy. Trump proved that on Tuesday night by highlighting the goal of eliminating deadly diseases by shining a spotlight on plucky little Grace Eline.
To be sure, in the wake of the State of the Union, other issues will loom larger. And yet over time, the American people will smile upon those politicians who can prove that they are looking out for our actual physical health.
James P. Pinkerton is an author and contributing editor at The American Conservative. He served as a White House policy aide to both Presidents Ronald Reagan and George H.W. Bush.