The Washington Post - 03.03.2020

TUESDAy, MARCH 3 , 2020. THE WASHINGTON POST eZ re A23

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etween coronavirus and Obamacare sabotage, the 2020 presidential race is shaping up to be yet another election driven by health care. Which might deliver another coveted victory to Democrats. Not because Democrats have done a lot right but, rather, because Repub- licans keep doing everything wrong. Ahead of the 2018 midterms, D emocrats had an undeniable advantage on health care. Polls consistently showed it as a top campaign issue, and nearly half of political ads in federal races mentioned it. Republi- cans had just spent the previous year trying to repeal the Affordable Care Act, and voters had finally figured out what they stood to lose: protections for preexisting conditions, the Med- icaid expansion and other popular provisions. After eight years of playing defense on health care, D emocrats were at l ast on offense. T he p ublic saw Democrats as protectors of Obamacare and awarded the party control of the House. But Democrats being Democrats, they soon squandered their advantage. Almost immediately, Democrats launched a divisive debate over h ow t o improve the current system. Some on the far left demanded that Democrats commit to abolishing private health insurance, which would involve taking employer-based plans away from some 180 million Americans who might b e averse to giving them up. The amount of blowback a fter O bamacare canceled objectively bad insurance plans for j ust a few million Americans suggests how toxic a single-payer-or- bust purity test could be. Democrats had put themselves back on defense and had somehow turned a n issue that should have b een an unalloyed advantage into a political l iability. Luckily for them, Republican in- competence and heartlessness have again c ome to Democrats’ r escue. In t he y ears since the GOP tried and failed (and tried, and failed) to repeal Obamacare legislatively, Republicans continued a sort of b ackdoor s abotage of the law. They’ve made numerous subtle changes, such as expanding the avail- ability of junk insurance plans that look like a good deal until you get sick and realize the plans don’t cover nec- essary care. They cut funds for mar- keting campaigns that alert people about open enrollment periods. They added (probably illegal) Medicaid work requirements and announced a plan to convert part of Medicaid into block g rants. Just last month, the administration

implemented an immigration rule that has frightened and confused fami- lies into disenrolling U.S.-citizen children from M edicaid and the Children’s Health Insurance Program. Many of these changes have largely flown under the political radar. But the prospect of a public health crisis has d rawn more attention t o the holes in our health-care system — i ncluding those that may have predated Presi- dent Trump but have widened under his leadership. For instance, the rise in uninsured rates since 2016 — a direct result of the GOP’s Obamacare sabotage — takes on new salience. Stories of Americans stuck with big bills for coronavirus testing and hospital stays are likely to discourage people who are uninsured or underinsured from getting screened a nd t reated. The Trump administration has made plenty of other unforced errors on health policy, many of which are directly related to its handling of the coronavirus epidemic or otherwise laid bare b y it. The president has made clear that he cares more about threats to the stock market than those to public health and has spread misinformation about the risks for both. Trump and h is underlings have attacked government experts, including scientists and doctors. And the government’s coronavirus response team is being overseen by a v ice president n otorious for bungling a previous public health crisis. Even before concerns about a global pandemic, voters were saying that, once again, health care would be t heir top issue in the coming election. If these developments weren’t enough to convince voters they can’t trust Republicans on health care, perhaps some news that broke Monday will: The Supreme C ourt s aid it would hear another case challenging t he constitu- tionality of the Affordable C are Act. The case will be h eard i n the court’s next term — possibly before the No- vember election — and the Trump administration still says it wants the law struck down. It also still doesn’t have a replacement plan if the court were to acquiesce. This, too, repre- sents not only terrible policy but also terrible politics. Republicans suggest it is somehow improper or unpatriotic for critics to point out the administration’s failures in its handling of coronavirus. They say Democrats should stop trying to capitalize on Republican health- p olicy screw-ups. To that Democrats should simply reply, as Republicans have in the past: Well, then stop screwing up. [email protected]

CATHERINE RAMPELL

Time for another

health-care election

H

ow long have U.S. troops b een in Afghanistan? S o long, a pparent- ly, that even the New York T imes sometimes forgets why they went in the f irst place. A front-page news story in the paper’s Feb. 28 edition reports that the conflict started “as an act of vengeance by the United S tates in 2001.” “Vengeance” for what? The Times story didn’t say — though the United States acted i n justified response to the S ept. 11, 2001, terrorist attacks on t he paper’s o wn hometown (and o n the Pentagon), which left m ore than 3 ,000 people dead. The invasion began Oct. 7, 2001, duly authorized by Congress, and backed by allies such as Canada, Australia, Britain, France and Afghan militias. Its goal was to root out the al-Qaeda terrorists responsible for 9/11 and topple the Ta liban Islamist fundamentalist dictatorship that sheltered them. Long, long after those valid, finite ob- jectives had been won — no small accom- plishment — t he United States and NATO allies remained, pursuing a more elusive project: a sustainable, reasonably democratic, pro-Western government in Kabul. That effort has cost hundreds of bil- lions of dollars and tens of thousands of lives — both American and (mostly) Af- ghan. Ye t the U.S.-backed government controls only a third of the country and 46 percent of the population, according to the Foundation for Defense of Democ- racies, with the rest either contested or under Taliban rule. It i s understandable t hat many A meri- cans have lost track of what this more than 18-year-old war is, or was, about. Forty-five percent of us say the United States made the right decision by going into Afghanistan and 39 percent say it was wrong to do so, according to a 2018 Pew Research C enter p oll. A nd it is therefore understandable that President Trump would pursue a negotiated exit for the roughly 13,000 U.S. military personnel who remain. Any president would be tempted to try. As far back as 2009, a top adviser to then-President Barack Obama urged h im to slash what was at the time a 30,000- troop U.S. contingent, abandoning the goal of protecting Afghan civilians from the Taliban i n favor o f more limited drone strikes, special forces missions and bombing r aids against a l-Qaeda. The top adviser? Vice President Joe Biden. We’ll never know what would have happened if Obama had adopted the Biden plan, just as we’ll never know what would have happened if President George W. Bush had decided to exit Af- ghanistan in 2002 after dealing what was, in hindsight, a permanently crip- pling blow to al-Qaeda — or if he had remained focused on Afghanistan rather than opening a costly n ew w ar w ith Iraq. What we do know is that the strategy Obama adopted, a counterinsurgency campaign led by 100,000 troops, yielded mixed r esults. And here we are. Trump’s approach — a U. S. pullout over the next 14 months in return for Taliban promises to shun terrorists and talk power-sharing with Ka- bul, with the United States reserving the right to hit terrorists — bears a passing resemblance to P lan B iden. Also striking is its similarity to Presi- dent Richard M. Nixon’s 1973 Paris Peace Accords, which got the United States out of Vietnam. Just as Trump struck his Ta liban deal with little input f rom Kabul, Nixon negotiated w ith North Vietnam over the h eads of our allies in South Vietnam. Then, as now, the president’s g oal w as a politically beneficial way out of an “endless war” inherited from predecessors — not a long-term s tabilization p lan. Fighting between North and South Vietnam paused but never really ended until April 30, 1975, when the North’s troops conquered Saigon; the United States, politically exhausted and distract- ed by Watergate, did nothing to stop them. In Afghanistan, there are already reports of resumed Ta liban attacks after a confidence-building week of violence “reduction” e nded Saturday. President Ashraf Ghani in Kabul is balking at the release of 5,000 Taliban prisoners; the Ta liban considers t his part of its deal with Trump, but it’s one of Ghani’s f ew b argaining chips. Though we must hope for the best, chances are Trump’s deal won’t prove more workable than the Paris Peace Ac- cords. Afghan allies, including girls and women who enjoyed a measure of human rights i n areas l iberated from the Ta liban, are a t risk. Ye t war isn’t “working,” either. In De- cember 1989, Spy, a brilliant but now defunct humor magazine, published a tournament-style bracket depicting his- torical conflicts as if they were NCAA basketball contests. “The World Championship,” as Spy titled it, had Vietnam over the United States in one semifinal, in “overtime.” In the other, Afghanistan, which had previ- ously beaten Britain, also in “overtime” (between 1838 and 1878), defeated the Soviet Union. Spy pitted Vietnam against Afghani- stan i n the finals, but left a question m ark in the space marked “ Champs.” Thirty-one years later, that satire has lost none of its relevance, o r its sting. [email protected]

CHARLES LANE

An Afghan

exit with

shades

of Vietnam

I

f the coronavirus is to b e successfully contained, President Trump will have to rely on both the government experts he calls the “deep state” and the n ews media he c alls t he “enemy of the people.” I have a hard time being o ptimis- tic t hat he w ill ask for t he help he n eeds. The irony would be delicious if the situation were not so serious. In China, the epicenter, the death rate from covid-19 — t he disease caused by the coronavirus — has reportedly been about 2 percent. Though different countries have reported different mortality rates, that figure would make the virus 20 times more deadly than the seasonal flu. We k now the virus is spreading here, as evidenced by a cluster of cases of covid-19 in the Seattle area, but we have no idea how widespread it is because we have done so little testing. As o f the weekend, the Centers for Disease Control and Prevention had conducted only about 500 tests; health authorities in Britain, by contrast, had done more than 10,000 tests. The number of confirmed deaths from covid-19 is rising: Washing- ton state authorities announced four more fatalities on Monday. Trump has spent his presidency deni- grating the “permanent federal bureau- cracy,” which he accuses of being unac- countable and d isloyal. Now, h owever, h e must count on l ongtime officials at a gen- cies such as the CDC and the National Institutes of Health to understand this dangerous new pathogen and limit its spread. You can bash bureaucrats all you want, but sometimes you really need them. And the federal government employs some of the best. One sterling e xample is Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infec- tious Diseases. If there were such a thing as the “deep state,” he could be its poster child. Fauci, a world-renowned scientist who has held his position since the Rea- gan a dministration, i s best known for his work during the initial AIDS crisis. He was instrumental in discovering how HIV overcomes the body’s defenses and pointing toward ways to slow or halt the progression to AIDS. Fauci also devel- oped therapies for several other rare f atal diseases and has w on prestigious a wards for his contributions to the field of rheu- matology. In 2008, President George W. Bush awarded him the Presidential Medal of Freedom. Ye t Fauci’s a ppearances on the Sunday talk shows this weekend were abruptly canceled, prompting concerns that he had b een muzzled b y the a dministration.

Fauci explained that this was not the case. But the alarm was understandable. When Trump p ut V ice President Pence i n charge of the federal response to the virus, one of Pence’s first acts was to centralize the administration’s “messag- ing” to the public. In principle, that makes sense: Mixed signals would be counterproductive. In reality, however, this administration has squandered so much credibility on Dear-Leader-style aggrandizement of Trump that it’s hard to believe political appointees are telling the t ruth. Trump’s attempts to sow distrust of civil servants could interact in particu- larly dangerous ways with his efforts to demonize the m edia in this epidemic. The president has made a systematic effort to delegitimize the media, calling our reports “fake news” and even accus- ing us of treason. But now he needs citizens to follow the government’s rec- ommendations and i nstructions — a bout handwashing, face masks, testing and the l ike — a nd this i nformation c annot b e fully disseminated except via the same news outlets Trump accuses of always “lying.” He has no choice but to ask his followers t o believe us, j ust this once. Health a nd Human Services Secretary Alex Azar said Sunday that enough new and improved diagnostic kits to test 75,000 people will be distributed to hos- pitals. That should allow officials to de- tect any hidden clusters of disease, such as the one being investigated in the Seat- tle area — but the government will need the media to get word out about testing protocols. And on Monday, Surgeon General Je- rome Adams asked that healthy Ameri- cans stop buying surgical face masks, which a re o nly useful — a nd n ecessary — for health-care workers and individuals who are already sick. Adams conveyed that message on “Fox & Friends” — Trump’s favorite show — b ut t he p rogram has fewer than 2 million viewers on an average morning. To the extent that Ad- ams’s message reaches more of the public, the conduits will necessarily include other media outlets that Trump routinely attacks and d enigrates. Obliterating long-accepted norms of public discourse has consequences. This administration has spent three years in- sisting on conspiracy theories, “alterna- tive facts” and the supposed infallibility of Trump. The White House insists on its own version of reality. The coronavirus, apparently, didn’t get the m emo. Twitter: @Eugene_Robinson

EUGENE ROBINSON

On coronavirus, Trump

needs the entities he hates

T

he United States is entering a disturbing new stage in the coronavirus outbreak. There has been community spread i n at l east one location, and likely two, in Washington state. And it appears the virus was being transmitted for several weeks before the current c ases were recognized. So we can expect dozens or hundreds of cases in those locations, unless contact tracing is especially efficient. The disease is loose and easily transmitted. The crucial issue now is the real mortality rate, which remains uncertain. The stated mortality is 2 percent. U.S. experts are hoping the rate turns out to be considerably lower. But the math remains troubling in any case. If only 5 percent of the U.S. population is even- tually infected (which is on the low side of some estimates) and the mortality rate is 1 percent, there still would be over 150,000 deaths. At this stage, the main t ool t hat public health e xperts have is s ocial distancing — the attempt to keep as many people as possible in affected areas out o f sneezing distance from one another. This means measures such as closing schools, cancel- ing events in theaters and stadiums, and encouraging employees to telework. States and localities ultimately make these decisions rather than the federal government. But according to some health experts I consulted, Washington state should be taking such measures right now. The goal of these policies is to keep the “R0” ( basic reproductive number) as low as possible. When people are in proximity, a single infected person can spread the disease to several others, boosting the R0 of the disease to as high as 2 or 3 and causing an exponential increase in cases. If the R0 is less than 1, the epidemic will gradually decline and stop on its own, with or without a vaccine. A vaccine, however, would be tremen- dously helpful. At least 10 coronavirus vaccine development p rojects are under- way, according to U.S. health officials. But the one furthest along at the Nation- al Institutes of Health is still about six weeks a way from starting the process o f a phase-one trial in human volunteers that will take three to four months to com- plete and to show (hopefully) that the vaccine is safe and produces specific antibodies. A phase-two trial will follow and will take at least six to eight months to determine whether the vaccine is effi- cacious in people at risk for infection.

Then production would need to be scaled up by a p harmaceutical company willing to deal with a global crisis. A ll this i n total will take at l east a year — a ssuming there are no unpredicted scientific obstacles in the w ay. The United States is now faced with two related but distinct problems: dealing with the virus and dealing with the public panic the virus may spark. The current administration is well prepared to handle the virus, and spectacularly ill-prepared to handle t he p anic. Upper-level health officials in the administration deserve our confidence. The Centers for Disease Control and Prevention has the world’s best public health professionals. The experts and researchers at NIH are brilliant and tire- less. The Food and Drug Administration will do what is required of it without cutting corners. And Health and Human Services Secretary Alex Azar is a mature adult who knows how to manage under stress. Below the level of the White House, the U.S. government i s well suited to the difficult task b efore it. But our country may be poorly prepared for the panic that is coming. “We are living at a nadir of trust in experts and public authorities,” Yuval Levin of the American Enterprise Institute told me, “and we are awash in channels for conspiracy and misinformation.” Presi- dent Trump — g iven his own conspirato- rial approach to facts — is perfectly unsuited to lead in a moment such as this. He has shown a strong tendency to trust outside information over inside information and to interpret any differ- ence between the two as evidence the insiders are lying to him. He might believe whatever he hears on Fox News and deny what he hears from public health professionals. And all this would happen in public view, creating dangerous confusion. There is every reason to be concerned about how Trump will behave if and when the schools start closing, travel is restricted, big events such as the Olym- pics have to be canceled and t he economy falls into recession. It is a test he is uniquely prepared to fail. His immediate tendency in such a crisis is to assume there is a plot against him and to search for scapegoats. And his flailing failure would only worsen the country’s general distrust of a uthority. America is better prepared for the virus than for the panic, and the biggest obstacle to containing any panic may prove to be the p resident h imself. [email protected]

MICHAEL GERSON

A test Trump is uniquely

prepared to fail

Drew angerer/agenCe FranCe-Presse/getty Images Medicare-for-all supporters o n Feb. 2 5 in Charleston, S.C.

JENNIFER RUBIN

excerpted from washingtonpost.com/people/jennifer-rubin

T hank you, Amy Klobuchar Just as those who praise moderation, smarts, good policy and responsible governance were sorry to see former South Bend, Ind., mayor Pete Buttigieg leave the race, the departure of Sen. Amy Klobuchar (D-Minn.) on Monday will be disappointing to many voters. Her run suggests that a smart candidate with e xcellent d ebate skills can get far — j ust not far enough. Klobuchar was a breath of fresh a ir in this campaign. She kept the campaign and her party tethered to reality, criticizing “free everything for everyone,” ably defending a responsible internationalist approach and deriding Medicare-for-all a s not politically possible. She reminded us that passing bills that help people is what legislators should do, not simply stick their fingers in the eyes of those who are willing to compromise. Of all the female candidates, she found the best balance on the debate stage between toughness and compassion and between seriousness and humor. She got out, like Buttigieg, t o prevent the center-left in the party from splitting the vote. If the Democrats win in November with former v ice p resident Joe Biden as the nominee, some o f the credit w ill go t o them. In a real sense, Biden, Klobuchar and Buttigieg have rebutted the media narrative that the Democratic Party has gone as far to the left as Republicans have to the right. There is a critical mass of the party that rejects the populism of the left and knows

that the center-left — n ot the far left — i s the way to unite the party and appeal to independents and former Republicans. Klobuchar, who often seemed hostile to Buttigieg on the debate stage, should recognize they are on the same team, not only in beating President Trump but in grounding the D emocratic Party in the t urf between the two 40-yard lines where the governing gets done. Her ideas for prescription drug cost containment, affordable college for working-class kids (not the super rich), sensible gun laws, immigration reform (without legalizing illegal b order crossings) and a transition to a green-energy economy are precisely the sort of reforms the country could rally around. On the c enter-left, the only straggler who remains in the race to compete with Biden for that swath of the party is former New York mayor Mike Bloomberg, whose half- a -billion dollar spending spree and quixotic campaign seem to be flopping. He said he e ntered the race to stop Sen. Bernie Sanders (I-Vt.); now he should follow the example of lifelong Democrats Klobuchar and B uttigieg and exit the race. It pains me when the worker bees and the optimistic centrist wonks do not win. But we should be grateful they are there to prevent both parties from losing their minds a nd c onsigning us t o four more years of Trump. Klobuchar ran an honorable, smart race and served her country well in leaving a t the right time.

The Washington Post - 03.03.2020

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