The poor US pandemic response will reverberate in health care politics for years
Much has been written about the U.S. coronavirus response. Media accounts frequently turn to experts for their insights – commonly, epidemiologists or physicians. Countless surveys have also queried Americans and individuals from around the world about how the pandemic has affected them and their attitudes and opinions.
Yet little is known about the views of a group of people particularly well qualified to render judgment on the U.S.'s response and offer policy solutions: academic health policy and politics researchers. These researchers, like the two of us, come from a diverse set of disciplines, including public health and public policy. Their research focuses on the intricate linkages between politics, the U.S. health system and health policy. They are trained to combine applied and academic knowledge, take broader views and be fluent across multiple disciplines.
To explore this scholarly community's opinions and perceptions, we surveyed hundreds of U.S.-based researchers, first in April 2020 and then again in September. Specifically, we asked them about the U.S. COVID-19 response, the upcoming elections and the long-term implications of the pandemic and response for the future of U.S. health policy and the broader political system.
Overall, the results of our survey – with 400 responses, which have been published in full in our recent academic article – paint a picture of a damaged reputation to government institutions. Surveyed scholars also believe the poor government response will shift the politics of health care. At the same time, our findings don't show strong belief in major policy changes on health.
Parceling out the blame
We first asked respondents how much responsibility various actors bear for the lack of preparedness in the U.S. Here scholars overwhelming assign blame to one source: 93% of respondents blamed President Trump for the overall lack of preparedness “a lot" or “a great deal." Moreover, 94% in April and 98% in September saw political motivations as the main drivers of the president's actions.
The Centers for Disease Control and Prevention and the Food and Drug Administration, as well as Congress, also deserve a significant amount of blame, survey respondents said. At the other end of the spectrum, scholars were relatively content with the response by local and state governments as well as that of the World Health Organization.
Notably, perceptions grew significantly more negative for all entities between April and September. This likely reflects frustrations with the continued inability to rein in the spread of the virus.
Effects on the political system and health policy
Respondents also offered a particularly grim view of the long-term implications of the failed coronavirus response for the United States.
Survey after survey has shown that partisanship influences individuals' perceptions of the coronavirus pandemic. Early research indicates that right-leaning media and presidential communication may have significantly contributed to these discrepancies and increased polarization.
And according to scholars in our study, these stirred-up partisan differences may lead to increases in distrust in government, a lack of faith in political institutions and even further growth in political polarization in the long term.
Overall, scholars were generally skeptical about any major progressive changes like the adoption of universal health care, paid sick leave, or basic income in the aftermath of the pandemic. At the same time, they also do not expect popular conservative changes like the privatization of Medicare or block grant Medicaid, which restricts expenditures from the federal government to states to a set lump sum.
Once more, hyperpartisanship, combined with the cumbersome political process, is seen as the major culprit here.
There is one major exception: adoption of a federal public option, a government-run health plan to compete with private insurers. Here, more than 60% of scholars initially thought that adoption would be somewhat or very likely in the next five years; however, this number dropped to 50% by September. This expectation appears to be driven by the expectation of a Biden presidency.
Two-thirds of respondents expected public health, health infrastructure, and pandemic preparedness to take on more prominent roles going forward. Just under half expected a larger focus on inequalities and inequities. Yet, with major reforms unlikely, scholars are generally skeptical about much progress on the issues.
To health policy and politics scholars, this came as no surprise. In the U.S., the pandemic collided with a political system rife with distrust and polarization. Both pathologies are mirrored among the American public. Large parts of the population are wary of the role scientists play in policy. Many subscribe to conspiracy theories.
This combination, together with poor leadership, has put coordinated and sustained policy response out of reach.
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To make things worse, the coronavirus has also highlighted the ubiquitous inequities in American society. It has also laid bare the inadequacies of the safety net or other social protections like paid sick leave.
In our view, no matter the outcome of the elections, the impacts of the failed coronavirus response will likely reverberate through the U.S. political system for decades. Much rebuilding will need to be done.