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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
November 9, 2020
Building Back Better
Alan B. Cohen
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This is part of the Building Back Better series.
Dear President-elect Biden:
As you well know, 2020 has been an unusually traumatic year for the United States. COVID-19 has sickened more than 9 million Americans, claimed more than 233,000 lives, and exposed serious limitations in our public health preparedness and in our health care system’s ability to deliver health care effectively and equitably. The pandemic’s economic effects have cost millions of Americans their jobs, their livelihoods, and their health insurance. Thousands more have lost their homes and businesses to devastating hurricanes and unprecedented wildfires. And the senseless murders of Black citizens by police officers have sparked widespread protests and civil unrest, the likes of which the nation has not seen in almost 50 years.
These public health, economic, and racial injustice calamities pose existential threats to the security and well-being of the nation. As president, you will face the difficult task of charting a course by which the nation may tackle and overcome these threats. This includes restoring the public’s faith in science and its trust in government to serve and protect the American people. Americans expect their president to be an all-embracing leader who empowers them to live healthy, productive lives. Your message of unity, compassion, and perseverance in the face of these hardships demonstrates that you understand the dangers threatening our democracy, and your solemn pledge to serve as president to all Americans inspires hope for the future.
The Milbank Quarterly is a multidisciplinary journal of population health and health policy. Our editorial team shares your desire to see evidence-based policies implemented that will help the nation “build back better.” In that spirit, we aim to share with you policy insights and recommendations from members of our Editorial Advisory Board, several of whom have had extensive experience in government, serving in Democratic as well as Republican administrations. Some also have held positions in state government, and many have served on national and state advisory committees and commissions. Their collective wisdom and insights on a number of critical health issues may benefit your transition team as it plans for the transfer of power on January 20, 2021.
Over the course of the transition period, we will present for your consideration policy ideas and strategies in three broad areas:
In the coming weeks, these are just some of the topics that Editorial Advisory Board members will address:
We begin, however, by outlining the most urgent tasks requiring swift executive action, namely the reversal of Trump administration policies that threaten or harm vulnerable populations, especially minority communities and low-income individuals and families.
As you know, over the past four years, the Trump administration has systematically dismantled Obama-era policies and programs across virtually all federal government agencies through a combination of executive orders, rule changes, policy statements, budget proposals, and major court challenges. While the net effect of these policy actions has been to strip away or nullify protections for all Americans, no group has been more disproportionately harmed or disadvantaged than communities of color, whose access to health care, fair housing, and safe environments has been severely curtailed.
For example, Black and Hispanic Americans gained the most in coverage, access, and utilization of health care through the Affordable Care Act (ACA). Yet, despite these gains, the Trump administration has consistently supported policy actions intended to eliminate or weaken the law. Moreover, people of color historically have faced discrimination and segregation in housing, and tend to live in communities more vulnerable to environmental hazards. Nevertheless, the Trump administration has sought to overturn Obama-era rules supporting the Fair Housing Act, and has actively worked to rescind various environmental protections and safeguards. In fact, The New York Times has identified 100 instances of administration attempts to reverse environmental regulations, including clean air and clean water rules. Perhaps the most sweeping retreat from environmental safety has been the administration’s decision to withdraw the United States from the 2015 Paris Climate Agreement.
Former Vice President Hubert H. Humphrey said that the moral test of a government is how that government treats its most vulnerable citizens—the children, the elderly, the sick, and the disabled. In order for your vision of “build back better” to be realized, the harmful policies of the Trump administration across the full spectrum of the federal government must be reversed and replaced with evidence-based policies that respect the dignity of all Americans and protect the most vulnerable within society.
The COVID-19 pandemic is a public health emergency that requires a coordinated national response to contain and mitigate the virus. We applaud your commitment to fight the pandemic by instituting a national mandatory mask requirement, implementing more robust testing and contact tracing, limiting the size of public gatherings, reversing many of the steps taken to reopen local economies, enforcing penalties for non-compliance with mitigation measures, and working with state and local officials to distribute vital equipment and supplies. Restoring the economy to pre-pandemic levels is an important goal, but it is secondary to containing the virus in the absence of effective vaccines and therapeutics.
As you prepare to take office as the nation’s 46th President, we urge you to undertake other immediate actions to protect the health and well-being of all Americans, particularly those that have been disproportionately affected. The five most pressing needs, in our view, are these:
To your credit, you already have articulated your intention to pursue most, if not all, of these actions through executive orders on Inauguration Day. But reversal of the destructive Trump executive orders and administrative rule changes may not necessarily be enough. Additional remedial actions, including potential legislation, may be required to undo the damage already done and to prevent further harm. However, with your leadership on all of these fronts, the nation will be set upon a new path that ultimately will assure a brighter, healthier, and more just future for generations of Americans to come.
We wish you and Vice President-elect Harris great success in these endeavors, and we look forward to offering more ideas and suggestions to your team as it formulates and implements sound public policies.
Alan B. Cohen became editor of The Milbank Quarterly in August 2018. He currently is a research professor in the Markets, Public Policy, and Law Department at the Boston University Questrom School of Business, and professor of health law, policy and management at the Boston University School of Public Health. He previously directed the Scholars in Health Policy Research Program and the Investigator Awards in Health Policy Research for the Robert Wood Johnson Foundation. Earlier in his career, he held faculty positions at Johns Hopkins University and Brandeis University, and spent 8 years at the Robert Wood Johnson Foundation. He is a member of the National Academy of Social Insurance. He received his BA in psychology from the University of Rochester, and his MS and ScD in health policy and management from the Harvard School of Public Health.
Amanda Katchmar is a Kilachand Honors College student and MPH candidate at Boston University.
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