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"Joe Manchin has moved into the position of doing Mitch McConnell’s job by obstructing forward motion on the long overdue social investment needed to move the country back from the abyss of the effects of the “trickle down economics.” (As a quick refresher, “trickle down” is the fake economic theory originated in the Reagan era that basically says if we make rich people and corporations richer, they will pull us all up. In a word, bullshit.)
It has been proven in the decades since that the money that flows upward stays there. This economic theory has gutted middle class America, made the idea of a one-breadwinner household a thing of the past and magnified environmental destruction while exploding military spending, medical costs and drug prices to name a few.
So what has this got to do with Joe Manchin? Everything. He has personal profit motivations to oppose efforts to remedy this situation. And, as the headline states, so does his family.
Let’s start with Joe. His opposition to the environmental aspects of the $3.5 trillion infrastructure investment being crafted is based on long-discredited opinions that reducing and eliminating the use of coal energy will not help. But the real deal is that he is heavily invested in coal and a considerable portion of his personal wealth is based on it.
For decades, Manchin has profited from a series of coal companies that he founded during the 1980s. His son, Joe Manchin IV, has since assumed leadership roles in the firms, and the senator says his ownership is held in a blind trust. Yet between the time he joined the Senate and today, Manchin has personally grossed more than $4.5 million from those firms, according to financial disclosures. He also holds stock options in Enersystems Inc., the larger of the two firms, valued between $1 and $5 million.
Another factor in the Manchin family mix is his daughter, Heather Bresch. She retired last year from her position as CEO of Mylan, the pharma company that bought the rights to the EpiPen. Bresch led the way in jacking up the prices of EpiPens to the nose-bleed levels they sell at today—in some cases as much as ten times what they sell for in other countries. Bresch presided over not only this, but also the complicated strategy of what is called a tax inversion, by merging with Abbot Labs and thus moved the company and its tax base to The Netherlands to avoid corporate taxes in the US.
This connects back to Joe Manchin in a couple of ways. A Washington Postarticlefrom 2016 details how Bresch got hired at Mylan in the first place. Joe got her the interview that led to her hiring. Factually, she started literally in the basement and rose the corporate ladder. A controversial MBA probably helped–controversial in that it was granted despite her being 22 credits short and was laterrescinded. As the referenced articles note, Joe Manchin was Governor of West Virginia at the time.
One of the components of the “human infrastructure” package being crafted by Congress is the expansion of Medicare. And this will finally include a restoration of the ability to directly negotiate drug prices. The current law outsources the negotiations to PMBs or Pharmacy Benefits Management companies—also known as the Pharma Benefits Mafia. The largest of these is CVS with a 32 percent share of the drug market in the US. If the Medicare expansion were to pass and the Medicare administration to regain direct negotiating power for drug prices, it could end the price-gouging gravy train drug companies like Mylan have been enjoying. And this would affect Joe Manchin’s daughter’s wallet.
We have covered Joe and Heather’s connections that seem to link directly to Joe’s opposition to the infrastructure package. There’s one more person in the mix: Joe’s wife, Gayle Manchin. Where does she fit in?
In 2016,USA Todayran a piece about Gayle Manchin. At the time she was on the National Association of State Boards of Education (NASBE), having been appointed by Joe when he was Governor of West Virginia.
After Gayle Manchin took over the National Association of State Boards of Education in 2012, she spearheaded an unprecedented effort that encouraged states to require schools to purchase medical devices that fight life-threatening allergic reactions.
The association’s move helped pave the way for Mylan Specialty, maker of EpiPens, to develop a near monopoly in school nurses’ offices. Eleven states drafted laws requiring epinephrine auto-injectors. Nearly every other state recommended schools stock them after what the White House called the “EpiPen Law” in 2013 gave funding preference to those that did.
Keeping it in the family takes on very specific and direct meaning with the Manchins. And Joe has demonstrated the ability to cast a blind eye to factors that negatively affect those outside the family circle.DemocracyNowposted a story earlier this year that gives major weight to this statement.
More than 1,400 workers in West Virginia are set to lose their jobs this week when the Viatris pharmaceuticals plant in Morgantown shuts down and moves operations overseas to India and Australia. Workers say they’ve had no response to their urgent requests for help from their Democratic senator, Joe Manchin, who is often called the most powerful man in Washington. Viatris was formed through a merger between two pharmaceutical companies, Mylan and Upjohn. Mylan’s chief executive, Manchin’s daughter Heather Bresch, got a $31 million payout as a result of the corporate consolidation before the new company set about cutting costs, including the closure of the Morgantown plant.
Lead, follow or get out of the way—the last is what Joe needs to do now. The information in this article took about 20 minutes to research. One wonders what would turn up with a comprehensive investigation."
Live Updates: Biden Signs Bill to Avert Government Shutdown, and Manchin Calls for $2 Trillion Cut to Biden’s Social Spending Plan
"The president signed the short-term spending bill, which funds the government until early December. Senator Joe Manchin III, a key holdout on the president’s social policy and climate bill, said he would support less than half of what top Democrats have proposed.
RIGHT NOW
The biggest guessing game in the Capitol: When will Pelosi hold the infrastructure vote?
transcript
Senate Votes to Avert Government Shutdown
The Senate passed a short-term spending bill to extend federal funding through early December, avoiding a government shutdown at midnight.
“Mrs. Blackburn, no.” “On this vote, the yeas are 65, the nays are 35. The 60-vote threshold having been achieved, the bill is passed.” Under the previous order, the Senate will proceed to executive session and resume consideration of the following nomination, which the clerk will report.”
The Senate passed a short-term spending bill to extend federal funding through early December, avoiding a government shutdown at midnight.Tom Brenner for The New York Times
Racing to avoid a government shutdown at midnight, President Biden signed a spending bill on Thursday evening that extends federal funding through early December and provides emergency aid to support both the resettlement of Afghan refugees and disaster recovery efforts across the country.
The president’s signature came after lawmakers hastily cleared the measure in both chambers earlier in the day.The Senate’s vote was 65 to 35; the House’s was 254 to 175.
“This is a good outcome — one I am happy we are getting done,” said Senator Chuck Schumer of New York, the majority leader, speaking on the Senate floor ahead of the vote. “With so many things happening in Washington, the last thing the American people need is for the government to grind to a halt.”
Lawmakers reached a deal on the spending legislation after Democrats agreed to strip out a provision that would have raised the federal government’s ability to continue borrowing funds through the end of 2022. Senate Republicans blocked an initial funding package on Monday over its inclusion, refusing to give the majority party any of the votes needed to move ahead on a bill to avert a first-ever federal default in the coming weeks.
The legislation keeps the government fully funded through Dec. 3, giving lawmakers additional time to reach consensus over the dozen annual bills that dictate federal spending. It provides $6.3 billion to help Afghan refugees resettle in the United States and $28.6 billion to help communities rebuild from hurricanes, wildfires and other recent natural disasters.
“This bill is not a permanent solution,” said Representative Rosa DeLauro of Connecticut, the chairwoman of the House Appropriations Committee. “I look forward to soon beginning negotiations with my counterparts across the aisle and across the Capitol to complete full year government funding bills.”
“The American people are capable of building a future that is stronger and more prosperous as long as they have the tools they need to do it,” she added. “This bill helps ensure that they have those tools.”
The disaster funding is intended to help communities across the country continue recovering from the damage inflicted in recent years by natural disasters, including Hurricanes Ida, Delta, Zeta, and Laura, as well as wildfires, droughts and winter storms.
The aid for Afghan refugees including funds for emergency housing, English lessons and additional resources.
Before agreeing to the details of the spending bill on Thursday morning, the Senatedefeated an amendmentproposed by Senator Tom Cotton, Republican of Arkansas, that would have curtailed the duration of some of the benefits for Afghan refugees.
Senators also voted down an amendment, offered by Senator Roger Marshall, Republican of Kansas, that would have barred funds from going toward the implementation and enforcement of Mr. Biden’s coronavirus vaccine mandate, as well as an amendment that would deny lawmakers pay should they fail to pass a budget resolution and the dozen spending bills by Oct. 1.
transcript
Manchin Voices Support for a Slimmer Social Safety Net Bill
Senator Joe Manchin III of West Virginia for the first time stated publicly how much funding he would support in a reconciliation bill focused on social programs, saying that he could not vote for a package costing more than $1.5 trillion.
“I’m willing to sit down and work through that $1.5 [trillion] to get our priorities and they can come back and do later, and they can run on the rest of it later. I think there’s many ways to get to where they want to, just on everything at one time. No, no, my top line has not been — my top line has been $1.5 because I believe in my heart that what we can do and what the needs we have right now, and what we can afford to do without basically changing our whole society to an entitlement mentality. We’ll do in good faith. I’m trying to be as honest and upfront —” Reporter: “You said you talked to Joe Biden — about the $1.5 trillion number.” “We talked about that.” “What did he say about that?” “And he once — he’s really sincere. He would like to have a lot more than that. And I said, ‘Mr. President, I understand that it’s just — you know, hopefully you can respect.’ He’s always been so respectful. He said, ‘Hey, Joe, I’ll never ask you to go against your convictions.’”
Senator Joe Manchin III of West Virginia for the first time stated publicly how much funding he would support in a reconciliation bill focused on social programs, saying that he could not vote for a package costing more than $1.5 trillion.Tom Brenner for The New York Times
Senator Joe Manchin III of West Virginia, a centrist Democrat, said Thursday that he could not support a social safety net bill of more than $1.5 trillion, less than half the size of the package that President Biden and Democratic leaders have been trying to push through Congress.
In comments to reporters outside the Capitol, Mr. Manchin laid out publicly for the first time the general outlines of what he would be willing to support, putting detail to what he has said for weeks — that he could not vote for a package anywhere near the size of the sprawling $3.5 trillion plan Democrats sketched out in their budget blueprint.
Mr. Manchin’s relative silence on what specific proposals he would eventually support has frustrated liberals who have feared he would ultimately oppose an ambitious plan to expand health care, education, paid leave andanti-climate changeprograms, coupled with an array of tax increases on the wealthy and corporations.
“I’m willing to sit down and work through that 1.5 and get our priorities,” Mr. Manchin said, standing outside the Capitol as protesters heckled him nearby.Liberal Democrats who want a more expansive bill “can come back and do later, and they can run on the rest of it later. I think there’s many ways to get to where they want to — just not everything at one time.”
It was unclear whether going public with those details would help assuage or further anger liberal Democrats, who have threatened to oppose a $1 trillion bipartisan infrastructure package on track for a House vote on Thursday without substantial progress toward passing the second, far larger bill.
Still, the comments were his most forthcoming about his willingness to support the social policy plan, which Democrats plan to push through using a fast-track process known as budget reconciliation that shields fiscal legislation from a filibuster. Democrats are trying to pass the package over united Republican opposition, meaning they cannot spare even one vote in the evenly divided Senate.
Mr. Manchin said that he had informed Mr. Biden in the last week about his overall spending number and acknowledged that “he would like to have a lot more than that.”
Mr. Manchin spoke out about his position after the news of an agreement enshrining it, signed by both him and Senator Chuck Schumer of New York, the majority leader, leaked out on Thursday. The document, dated July 28, says that Mr. Manchin will not support any plan that lacks conditions for any new spending, income thresholds for social programs, accommodations for fossil fuel tax credits and natural gas, or does not devote any revenue exceeding $1.5 trillion to deficit reduction.
The agreement,obtained by Politicoand confirmed by two people with knowledge of it, said that Mr. Manchin “does not guarantee that he will vote for the final reconciliation legislation if it exceeds the conditions outlined in this agreement.”
Mr. Manchin’s memo also stipulated a number of demands to help the fossil fuel industry. It said that, in his role as chairman of the Senate Energy Committee, he must have full control over crafting the central climate change provisions of the legislation — all but ensuring that those provisions will be far less ambitious and more fossil-fuel friendly than Mr. Biden had hoped.
In addition, the memo demands that if the legislation were to include extensions of tax credits for wind and solar power, it would not undo tax breaks for fossil fuel producers.
Mr. Schumer, who signed the agreement as he was working to persuade Mr. Manchin to support the budget blueprint, also appears to have scrawled “I will try to dissuade Joe on many of these” underneath his signature.
On Thursday, a spokesman emphasized that Mr. Schumer did not consider it binding.
“As the document notes, Leader Schumer never agreed to any of the conditions Senator Manchin laid out; he merely acknowledged where Senator Manchin was on the subject at the time,” said Justin Goodman, the spokesman.
On Thursday, the office of Senator Kyrsten Sinema of Arizona, another moderate holdout on Mr. Biden’s plan, said she would not “negotiate through the press” but had made her priorities and concerns known to Mr. Biden and Mr. Schumer.
Coral Davenportcontributed reporting.
Speaker Pelosi continued to negotiate with liberal and conservative Democrats even as she declared the infrastructure bill was on track.Jason Andrew for The New York Times
Speaker Nancy Pelosi on Thursday vowed to push ahead with a House vote on a $1 trillion infrastructure bill that passed the Senate with bipartisan support, driving Democrats toward a showdown between moderate supporters of the bill and liberals who have said they will bring it down without progress on a separate social policy measure.
Democratic leaders told lawmakers that no votes would occur before 9 p.m., but did not rule out the possibility of completing work on the bipartisan bill Thursday evening.
Democrats entered Thursday juggling four consequential tasks on the final day of the current fiscal year: keeping the government open past midnight, ensuring it can pay its debts, securing the infrastructure bill and drafting a climate change and social safety net bill that the speaker called the “culmination” of her congressional career.
They accomplished the first task, as both the House and Senate managed to pass a bill to keep funding flowing into early December, removing the immediate threat of a government shutdown.
The rest is a mess. Liberal House members emerged from a meeting with the speaker at midday to say they would oppose passage of the infrastructure bill until the Senate pass a $3.5 trillion social policy bill that expands child care and early childhood education, creates a paid family and medical leave program and begins to tackle climate change, to name only a few provisions.
“The speaker really just wanted to see where we were, and we explained that we’re in the same place,” said Representative Pramila Jayapal, Democrat of Washington and the head of the Congressional Progressive Caucus.
But Senator Joe Manchin III, Democrat of West Virginia,told reportershe has no intention of voting for any social policy and climate change bill that costs more than $1.5 trillion over 10 years. His advice for Democrats who want a larger package: “Elect more liberals.”
Ms. Pelosi, speaking at her weekly news conference, stayed relentlessly optimistic, speaking of the common ground she shares with Mr. Manchin, a fellow Italian American and Catholic.
“Let me tell you about negotiating: You cannot tire,” she said.
Both the infrastructure and social policy bills are major priorities for President Biden, who invested ample political capital in the infrastructure compromise and has staked his presidency on enactment of a transformational social policy package.
White House officials declined to discuss the details of meetings and discussions with Mr. Manchin and the other Democratic hold out on the $3.5 trillion package,Senator Kyrsten Sinema of Arizona, which have intensified in recent days as some Democrats have grumbled that the president needed to play a bigger role in ensuring the success of his agenda.
Andrew Bates, a spokesman for the White House, rejected the criticism, saying Mr. Biden was doing precisely what he needed to.
“He knows how to make his case, he knows how to count votes, and he knows how to deliver for the American middle class,” Mr. Bates said.
But it was unclear, with Republican leaders in the House urging their members to oppose the bipartisan infrastructure bill, whether the legislation could overcome liberal defections on Thursday.
Speaker Pelosi just before signing a bill extending government funding on Thursday. The timing of a vote on a separate infrastructure bill remained uncertain. Sarahbeth Maney/The New York Times
“That’s the path,” Speaker Nancy Pelosi declared, as she zipped between her office and the House chamber, surrounded by her security detail and a gaggle of reporters. “That’s the one we’re on. And it’s still on.”
Ms. Pelosi may be on a path, but with President Biden’s infrastructure bill still in limbo on Thursday evening, nobody in the Capitol seemed to know quite what that path was.
Ms. Pelosi had promised the House would vote Thursday on the bill. Instead, rank-and-file Democrats and members of the Democratic leadership team trooped in and out of the speaker’s suite on the second floor of the Capitol for much of the day, as Ms. Pelosi tried to round up the necessary votes to pass the measure.
Liberals were balking, insisting they would vote no unless the measure was paired with an expansive social policy bill. Moderates were frustrated; they need to show their constituents that they are doing something — anything — and are eager for the vote. The question of the day was: Would the bill come to the floor, as Ms. Pelosi had promised? Nobody seemed prepared to offer an unqualified “yes.”
“I don’t know,” Representative Jim Clyburn of South Carolina, the No. 3 House Democrat, told reporters who asked if the vote would come Thursday night. Mr. Clyburn is the Democratic whip — the leader responsible for counting (or in congressional parlance, “whipping”) votes. But for this bill, at least, it appears the one cracking the whip is Ms. Pelosi.
The No. 2 Democrat, Representative Steny D. Hoyer of Maryland, did not have much to add. Are you confident, he was asked, that if the bill came to the floor it would pass? “I’m confident that a majority of members are for it,” he said, leaving open the possibility that being for it and voting for it are not the same thing.
As afternoon headed toward evening, reporters were taking bets. Would the vote come at midnight? 1 a.m.? Later? Was there an ample supply of caffeine in the press gallery? Some in the Democratic rank and file were growing frustrated.
“We’ve been told over and over that we’re voting on this today,” said Representative Elissa Slotkin, a centrist Democrat from Michigan. “All the caucuses that I’m part of have been telling me that we’re voting on this today. We’re just waiting, for standby, on when.”
At 5:45 p.m., she got her answer — sort of. The House went into recess, with no votes scheduled until at least 9 p.m.
The $1 trillion infrastructure bill passed in the Senate with bipartisan support but is threatened in the House by Democrats wanting the reconciliation bill to pass.Patrick T. Fallon/Agence France-Presse — Getty Images
In a pivotal week, in a make-or-break stretch for President Biden’s domestic agenda, congressional Democrats are trying to assemble a puzzle of four jagged pieces that may or may not fit together.
Making them work as a whole is critical for the party’s agenda and political prospects. Failure could have major electoral and economic consequences — including the potential of a first-ever default on the government’s debt that could precipitate a global financial crisis. Here are all the moving parts.
Piece 1: Government funding.
Lawmakers entered this week facing a critical deadline: At a second past midnight on Friday morning, the parts of the government that operate under the discretion of Congress’s annual spending process had been set to run out of money.
Oct. 1 is the beginning of the fiscal year, and with larger issues dominating their attention, the Democratic House and Senate have not completed any of the annual appropriations bills to fund the Departments of Defense, Transportation, Health and Human Services, State and Homeland Security, to name a few.
On Thursday afternoon, lawmakers averted a potential shutdown. The Senate passed a stopgap bill that would keep federal funding flowing into December and allow more time for the annual appropriations bills to be completed. The House quickly passed the bill as well, clearing the way for Mr. Biden to sign it and keep the government funded.
Piece 2: The debt limit.
Raising the debt limit is akin to paying off your credit card bill at the end of the month, because a higher borrowing ceiling allows the Treasury to pay creditors, contractors and agencies money that was already extracted from them in Treasury bonds and notes or contracts. It is not for future obligations.
Republicans have made it clear that they intend to filibuster an ordinary bill to raise the debt ceiling, as they did on Monday. For Democrats to do so unilaterally, they would most likely have to use a budget process called reconciliation that shields fiscal measures from a filibuster.
Doing so is a complex and time-consuming affair. It all has to be done in the next two to three weeks, to beat the rapidly approaching “X date” when the government defaults. Janet Yellen, the Treasury secretary, told Congress on Tuesday that the deadline is Oct. 18.
Piece 3: Infrastructure.
In August, with rare bipartisan swagger,the Senate passed a $1 trillion billto build or fortify roads, bridges, tunnels, transit and rural broadband networks. The 69 “yes” votes included Senator Mitch McConnell of Kentucky, the Republican leader, and 18 others from his party. Then it got more complicated.
Pressing for a quick vote on the bill, nine conservative-leaning Democrats in the House threatened to withhold their votes for the party’s $3.5 trillion budget blueprint until the Senate-passed infrastructure bill cleared their chamber. But now liberals in the House are threatening to withhold their votes for the infrastructure measure until the budget blueprint has successfully made its way through reconciliation.
Piece 4: Social policy reconciliation.
Democrats’ exceedingly ambitious social policy bill, which Mr. Biden calls his “Build Back Better” plan, is packed with longstanding party priorities. The House has drafted a2,465-page versionthat includes a huge array of programs to combat climate change, the extension of a generous child tax credit, universal prekindergarten, greatly expanded access to community college, increased resources for elder care and paid leave, and a Medicare expansion to cover vision, hearing and dental care — all paid for by trillions of dollars in tax increases on corporations and the wealthy.
Speaker Nancy Pelosi had hoped to put it to a vote this week, but she faced two problems: As of now, Democrats most likely do not have the votes, and Senate Democratic leaders have yet to produce a detailed bill that can draw the support of every member of their caucus.
Several conservative-leaning Democrats in both chambers, including Senators Joe Manchin III of West Virginia andKyrsten Sinema of Arizona, have said they cannot support the plan as proposed. And because Republicans have made it clear they are unified in their opposition, Democrats cannot afford to lose even one vote from their party in the Senate and can afford to lose as few as three votes in the House.
Mr. Biden has been negotiating with the holdouts to determine what they could support. But for now, the lack of agreement on the sprawling plan is blocking its progress — and leaving the fate of the infrastructure measure uncertain as well.
The bill includes $66 billion in new funding for railways to address Amtrak’s maintenance backlog.Bryan Anselm for The New York Times
Amtrak would see its biggest infusion of money since its inception a half-century ago. Climate resilience programs would receive their largest burst of government spending ever. The nation’s power grid would be upgraded to the tune of $73 billion.
The sprawling,$1 trillion bill that the Senate passed last month—a bipartisan dealthat is the product of months of negotiating and years of pent-up ambitions to repair the nation’s crumbling infrastructure — would amount to the most substantial government expenditure on the aging public works system since 2009. It includes $550 billion in new funds and the renewal of an array of programs otherwise scheduled to expire at the end of September.
It is also stuffed with pet projects and priorities that touch on nearly every facet of American life, including the most obscure, like a provision to allow blood transport vehicles to use highway car pool lanes to bypass traffic when fresh vials are on board and another to fully fund a federal grant program to promote “pollinator-friendly practices” near roads and highways. (Price tag for the latter: $2 million per year.)
The measure represents a crucial piece of President Biden’s economic agenda, and the agreement that gave rise to it was amajor breakthrough in his quest for a bipartisan compromise. But it was also notable for the concessions Mr. Biden was forced to make to strike the deal.
For example, the legislation includes $73 billion to modernize the nation’s electricity grid, which energy analysts said would lay the groundwork for pivoting the nation off fossil fuels. But it contains only a fraction of the money Mr. Biden requested for major environmental initiatives and extends a lifeline to natural gas and nuclear energy, provisions that have angered House progressives.
Senator Bernie Sanders and colleagues have used budget tricks to get the cost of the bill to $3.5 trillion from an initial $6 trillion.Sarahbeth Maney/The New York Times
Paring back the Democrats’ $3.5 trillion domestic policy package will involve difficult choices for a party fractured by mistrust and competing priorities. But in a package that is intended to shape every facet of American life, including public education, health care and the environment, there is room for agreement, even in a thinly divided Congress.
Here are three possible scenarios for how to structure a final deal.
A slightly scaled-back plan that uses budget tricks to hold down the cost.
Senator Bernie Sanders, the Vermont independent and chairman of the Senate Budget Committee, initially urged his colleagues to embrace spending as much as $6 trillion over 10 years as they began drafting the bill.
To narrow the scope to its current price tag of $3.5 trillion over 10 years, aides said, Mr. Sanders and his colleagues employed budget gimmicks like setting earlier end dates on programs or narrowing their proposed size to lower their cost.
A lowest-common-denominator $900 billion package that extends existing health and child care benefits.
The easiest fallback for Democrats might be to extend the generous tax credits and other benefits created for a single year in the $1.9 trillion pandemic relief law, known as the American Rescue Plan. According to the Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog group, that skinny option would total $900 billion, still more than President Barack Obama’s 2009 stimulus plan, which, when it passed, was considered huge.
A middle-ground $1.5 trillion bill that invests huge resources in programs to combat climate change.
Progressive Democrats have indicated that they will not vote for the $1 trillion infrastructure bill without ensuring passage of the social welfare and climate change bill. To pass the former without the latter could actually make global warming worse, they argue.
To answer those concerns, Democrats could include the social welfare components of the lowest-common-denominator option — extending the temporary benefits of the American Rescue Plan — while also going big on climate change.
The reconciliation process allows Congress to advance certain spending and tax bills on a simple majority vote.T.J. Kirkpatrick for The New York Times
The budget reconciliation process allows Congress to advance certain spending and tax bills on a simple majority vote, freeing lawmakers in the Senate from the 60-vote threshold most legislation must meet to be considered. Democrats are aiming to use the process to pass the sweeping $3.5 trillion social safety net and climate change measure, which carries much of President Biden’s agenda, in the face of united Republican opposition.
The process begins with a budget resolution, which establishes a blueprint for federal spending and directs congressional committees to write bills to achieve certain policy results, setting spending and revenues over a certain amount of time. Its name refers to the process of reconciling existing laws with those directives. Here are some key things to know about the legislative maneuver.
The process is subject to strict rules that limit what can be included.
While reconciliation allows senators to scale procedural and scheduling hurdles, it is also subject to strict limits that could constrain the scope of any pandemic relief package Democrats seek to pass.
In the Senate, the “Byrd Rule,” established by former Senator Robert Byrd of West Virginia, bars extraneous provisions, including any measure that does not change revenues or spending, affects the Social Security program or increases the deficit after a certain period of time set in the budget resolution. It is intended to ensure that the reconciliation process cannot be abused to jam through any unrelated provision.
The rule’s name lends itself to a number of bird-related puns commonly used to describe the stages of the reconciliation process. There is the “Byrd bath,” when the Senate parliamentarian scrubs and analyzes a bill for any provision that violates the rule if a senator raises a concern about a violation. Anything that does not survive the scrutiny is known as a “Byrd dropping,” and is removed from the legislation before it can advance.
Vice President Kamala Harris could also overrule the parliamentarian, but that has not been done since 1975.
The process is in motion, but the legislative math is proving tough for Democrats.
A budget blueprint on the social spending and climate bill was advanced in August and committees have been working on drafting the reconciliation legislation, but key centrist Democrats in the Senate who have balked at the $3.5 trillion price tag have brought the process to an impasse as party leaders try to negotiate a compromise.
Because Republicans have made it clear they are unified in their opposition, Democrats cannot afford to lose even one vote from their party in the Senate. In the House, the math is almost as challenging; if every member voted, Democrats could afford to lose only three of their members and still pass the legislation.
Afghan refugees arriving at Dulles International Airport outside of Washington in August.Sarahbeth Maney/The New York Times
The Senate on Thursday rejected a Republican effort to use a spending bill needed to keep the government open past midnight to curtail assistance toAfghanswho were quickly evacuated to the United States as American troops withdrew from their country last month.
The proposal by Senator Tom Cotton of Arkansas was just one of a series of skirmishes over a bill that would extend federal funding into early December and provide emergency funding for the resettlement of Afghan refugees and disaster recovery. The legislation is expected to pass later Thursday with bipartisan support, but first, Republicans have demanded votes on several proposed changes.
Mr. Cotton’s proposal failed on a 50-to-50 vote, along party lines. Under Senate rules, a tied vote on a proposed change to a bill is not enough to amend the legislation.
The amendment would have cut offaidfor things such as housing, food and medical benefits after March 31, 2023, for Afghans who were granted parole to quickly enter the United States because of the urgent humanitarian crisis.
Mr. Cotton has argued that terminating the benefits is reasonable, considering that Afghans who received special visas for helping the American military may only receive such benefits for eight months.
The amendment also would have cut from the bill language that would have waived certain requirements for obtaining driver’s licenses or identification cards, making it easier for the Afghans to get them. Those who were granted humanitarian parole lack some of the documentation required under the REAL ID Act, which was created after the Sept. 11 terrorist attacks to enhance security on commercial airlines.
His amendment also attempted to force the Department of Homeland Security to work more quickly to process Afghan asylum applications, moving up the deadline to conduct a first interview with an applicant to 15 days instead of 45 days, and required the department to make a decision within 150 days of the application’s filing.
Before the vote, Senator Rob Portman, Republican of Ohio, said the amendment would ensure Afghan evacuees are “properly vetted.” But Senator Jeanne Shaheen, Democrat of New Hampshire, argued the amendment was unnecessary, saying the evacuees were already being properly vetted and it merely blocked badly needed benefits for those in dire need of help.
Senator Patrick Leahy, Democrat of Vermont and the chairman of the Appropriations Committee, touted the bill’s provisions to help Afghan evacuees in a speech on the Senate floor before the vote. He urged his colleagues to “strongly oppose” Mr. Cotton’s proposal and other amendments offered by the Republicans, warning that accepting any could slow down the process and result in a government shutdown.
“It provides critical assistance to Afghan refugees who fled the Taliban in the wake of the U.S. withdrawal from Afghanistan,” he said of the funding bill. “Many of those refugees worked with American forces and helped us.”
transcript
Biden and Pelosi Attend Congressional Baseball Game
President Biden and Speaker Nancy Pelosi were seen cheering on the sideline and talking to players at the annual Congressional Baseball Game as they tried to salvage two crucial pieces of Mr. Biden’s domestic agenda.
[crowd cheering] [crowd cheering]
President Biden and Speaker Nancy Pelosi were seen cheering on the sideline and talking to players at the annual Congressional Baseball Game as they tried to salvage two crucial pieces of Mr. Biden’s domestic agenda.Doug Mills/The New York Times
Lawmakers have been playing a lot of political hardball on Capitol Hill given the multiple crises consuming Washington, but it was actual hardball that drew Democrats and Republicans to Nationals Park on Wednesday night for the annual congressional baseball charity game.
The game provided a brief moment of camaraderie amid deep partisan division and high drama in Congress, as leaders rushed to try to head off a government shutdown and a potential federal default while Democrats toiled to bridge bitter rifts among them over a huge piece of social policy.
It also offered yet another venue for the Democrats to try to corral votes for a $1 trillion infrastructure bill slated for a House vote later Thursday, which currently appears far short of the support needed to pass given liberal defections.
President Biden — a former participant in his Senate days — made an extended appearance, even mingling in the Republican dugout with his political foes. Speaker Nancy Pelosi was also on hand to do what she usually does — exhort her fellow Democrats to deliver a win. They did not in this case, falling to the Republican lineup 13-12 in a close game that Ms. Pelosi must hope is not a harbinger for the tough votes she is facing.
The president drew a few boos from the Republican side of the stands, but was welcomed in the party’s dugout for photos and ribbing even though the red-uniformed G.O.P. lawmakers oppose almost everything on his legislative agenda. He handed out ice cream bars whose wrappers bore the presidential seal and took calls as he watched the game.
Ms. Pelosi could be seen on a telecast of the game feverishly working her own phone from the stands, with a crucial intramural Democratic showdown looming on the infrastructure measure, which progressives have threatened to sink until they get a vote on a $3.5 trillion social policy package that carries most of their priorities.
The play of the night, however, was an actual out-of-the-park home run by Republican Representative Greg Steube of Florida, an impressive feat in a game played by a bunch of amateurs well past their playing primes in most cases.
The big question after the game was how Ms. Pelosi and her party would fare when their moment at the legislative plate arrived."
A year after the United States bombed its pandemic performance in front of the world, the Delta variant opened the stage for a face-saving encore. If the U.S. had learned from its mishandling of the original SARS-CoV-2 virus, it would have been better prepared for the variant that was already ravaging India.
America’s frustrating inability to learn from the recent past shouldn’t be surprising to anyone familiar with the history of public health. Almost 20 years ago, the historians of medicine Elizabeth Fee and Theodore Brown lamented that the U.S. had “failed to sustain progress in any coherent manner” in its capacity to handle infectious diseases. With every new pathogen—cholera in the 1830s, HIV in the 1980s—Americans rediscover the weaknesses in the country’s health system, briefly attempt to address the problem, and then “let our interest lapse when the immediate crisis seems to be over,” Fee and Brown wrote. The result is a Sisyphean cycle of panic and neglect that is now spinning in its third century. Progress is always undone; promise, always unfulfilled. Fee died in 2018, two years before SARS-CoV-2 arose. But in documenting America’s past, she foresaw its pandemic present—and its likely future.
More Americans have been killed by the new coronavirus than the influenza pandemic of 1918, despite a century of intervening medical advancement. The U.S. was ranked first among nations in pandemic preparedness but has among the highest death rates in the industrialized world. It invests more in medical care than any comparable country, but its hospitals have been overwhelmed. It helped develop COVID-19 vaccines at near-miraculous and record-breaking speed, but its vaccination rates plateaued so quickly that it is now 38th in the world. COVID-19 revealed that the U.S., despite many superficial strengths, is alarmingly vulnerable to new diseases—and such diseases are inevitable. Asthe global population grows, as the climate changes, and as humans push into spaces occupied by wild animals, future pandemics become more likely. We are not guaranteed the luxury of facing just one a century, or even one at a time.
It might seem ridiculous to think about future pandemics now, as the U.S. is consumed by debates over booster shots, reopened schools, and vaccine mandates. Prepare for the next one? Let’s get through this one first! But America must do both together, precisely because of the cycle that Fee and Brown bemoaned. Today’s actions are already writing the opening chapters of the next pandemic’s history.
Internationally, Joe Biden has made several important commitments. At the United Nations General Assembly last week, he called for a new council of national leaders and a new international fund, both focused on infectious threats—forward-looking measures that experts had recommended well before COVID-19.
But domestically, many public-health experts, historians, and legal scholars worry that the U.S. is lapsing into neglect, that the temporary wave of investments isn’t being channeled into the right areas, and that COVID-19 might actually leave the U.S. weaker against whatever emerges next. Donald Trump’s egregious mismanagement made it easy to believe that events would have played out differently with a halfway-competent commander who executed preexisting pandemic plans. But that ignores the many vulnerabilities that would have made the U.S. brittle under any administration. Even without Trump, “we’d still have been in a whole lot of trouble,” Gregg Gonsalves, a global-health activist and an epidemiologist at Yale, told me. “The weaknesses were in the rootstock, not high up in the trees.”
The panic-neglect cycle is not inevitable but demands recognition and resistance. “A pandemic is a course correction to the trajectory of civilization,” Alex de Waal, of Tufts University and the author of New Pandemics, Old Politics, told me. “Historical pandemics challenged us to make some fairly fundamental changes to the way in which society is organized.” Just as cholera forced our cities to be rebuilt for sanitation, COVID-19 should make us rethink the way we ventilate our buildings, as my colleague Sarah Zhang argued. But beyond overhauling its physical infrastructure, the U.S. must also address its deep social weaknesses—a health-care system that millions can’t access, a public-health system that’s been rotting for decades, and extreme inequities that leave large swaths of society susceptible to a new virus.
Early last year, some experts suggested to me that America’s COVID-19 failure stemmed from its modern inexperience with infectious disease; having now been tested, it might do better next time. But preparedness doesn’t come automatically, and neither does its absence. “Katrina didn’t happen because Louisiana never had a hurricane before; it happened because of policy choices that led to catastrophe,” Gonsalves said. The arc of history does not automatically bend toward preparedness. It must be bent.
On September 3, the White House announced a new strategy to prepare for future pandemics. Drafted by the Office of Science and Technology Policy, and the National Security Council, the plan would cost the U.S. $65 billion over the next seven to 10 years. In return, the country would get new vaccines, medicines, and diagnostic tests; new ways of spotting and tracking threatening pathogens; better protective equipment and replenished stockpiles; sturdier supply chains; and a centralized mission control that would coordinate all the above across agencies. The plan, in rhetoric and tactics, resembles those that were written before COVID-19 and never fully enacted. It seems to suggest all the right things.
But the response from the health experts I’ve talked with has been surprisingly mixed. “It’s underwhelming,” Mike Osterholm, an epidemiologist at the University of Minnesota, told me. “That $65 billion should have been a down payment, not the entire program. It’s a rounding error for our federal budget, and yet our entire existence going forward depends on this.” The pandemic plan compares itself to the Apollo program, but the government spent four times as much, adjusted for inflation, to put astronauts on the Moon. Meanwhile, the COVID-19 pandemic may end up costing the U.S. an estimated $16 trillion.
“I completely agree that it will take more investment,” Eric Lander, OSTP director and Biden’s science adviser, told me; he noted that the published plan is just one element of a broader pandemic-preparedness effort that is being developed. But even the $65 billion that the plan has called for might not fully materialize. Biden originally wanted to ask Congress to immediately invest $30 billionbut eventually called for just half that amount, in a compromise with moderate Democrats who sought to slash it even further. The idea of shortchanging pandemic preparedness after the events of 2020 “should be unthinkable,” wrote former CDC Director Tom Frieden and former Senator Tom Daschle in The Hill. But it is already happening
Others worry about the way the budget is being distributed. About $24 billion has been earmarked for technologies that can create vaccines against a new virus within 100 days. Another $12 billion will go toward new antiviral drugs, and $5 billion toward diagnostic tests. These goals are, individually, sensible enough. But devoting two-thirds of the full budget toward them suggests that COVID-19’s lessons haven’t been learned.
America failed to test sufficiently throughout the pandemic even though rigorous tests have long been available. Antiviral drugs played a bit part because they typically provide incremental benefits over basic medical care, and can be overly expensive even when they work. And vaccines were already produced far faster than experts had estimated and were more effective than they had hoped; accelerating that process won’t help if people can’t or won’t get vaccinated, and especially if they equate faster development with nefarious corner-cutting, as many Americans did this year. Every adult in the U.S. has been eligible for vaccines since mid-April; in that time, more Americans have died of COVID-19 per capita than people in Germany, Canada, Rwanda, Vietnam, or more than 130 other countries did in the pre-vaccine era.
“We’re so focused on these high-tech solutions because they appear to be what a high-income country would do,” Alexandra Phelan, an expert on international law and global health policy at Georgetown University, told me. And indeed, the Biden administration has gone all in on vaccines, trading them off against other countermeasures, such as masks and testing, and blaming “the unvaccinated” for America’s ongoing pandemic predicament. The promise of biomedical panaceas is deeply ingrained in the U.S. psyche, but COVID should have shown that medical magic bullets lose their power when deployed in a profoundly unequal society. There are other ways of thinking about preparedness. And there are reasons those ways were lost.
In 1849, after investigating a devastating outbreak of typhus in what is now Poland, the physician Rudolf Virchow wrote, “The answer to the question as to how to prevent outbreaks … is quite simple: education, together with its daughters, freedom and welfare.” Virchow was one of many 19th-century thinkers who correctly understood that epidemics were tied to poverty, overcrowding, squalor, and hazardous working conditions—conditions that inattentive civil servants and aristocrats had done nothing to address. These social problems influenced which communities got sick and which stayed healthy. Diseases exploit society’s cracks, and so “medicine is a social science,” Virchow famously said. Similar insights dawned across the Atlantic, where American physicians and politicians tackled the problem of urban cholera by fixing poor sanitation and dilapidated housing. But as the 19th century gave way to the 20th, this social understanding of disease was ousted by a new paradigm.
When scientists realized that infectious diseases are caused by microscopic organisms, they gained convenient villains. Germ theory’s pioneers, such as Robert Koch, put forward “an extraordinarily powerful vision of the pathogen as an entity that could be vanquished,” Alex de Waal, of Tufts, told me. And that vision, created at a time when European powers were carving up other parts of the world, was cloaked in metaphors of imperialism, technocracy, and war. Microbes were enemies that could be conquered through the technological subjugation of nature. “The implication was that if we have just the right weapons, then just as an individual can recover from an illness and be the same again, so too can a society,” de Waal said. “We didn’t have to pay attention to the pesky details of the social world, or see ourselves as part of a continuum that includes the other life-forms or the natural environment.”
Germ theory allowed people to collapse everything about disease into battles between pathogens and patients. Social matters such as inequality, housing, education, race, culture, psychology, and politics became irrelevancies. Ignoring them was noble; it made medicine and science more apolitical and objective. Ignoring them was also easier; instead of staring into the abyss of society’s intractable ills, physicians could simply stare at a bug under a microscope and devise ways of killing it. Somehow, they even convinced themselves that improved health would “ultimately reduce poverty and other social inequities,” wrote Allan Brandt and Martha Gardner in 2000.
This worldview accelerated a growing rift between the fields of medicine (which cares for sick individuals) and public health (which prevents sickness in communities). In the 19th century, these disciplines were overlapping and complementary. In the 20th, they split into distinct professions, served by different academic schools. Medicine, in particular, became concentrated in hospitals, separating physicians from their surrounding communities and further disconnecting them from the social causes of disease. It also tied them to a profit-driven system that saw the preventive work of public health as a financial threat. “Some suggested that if prevention could eliminate all disease, there would be no need for medicine in the future,” Brandt and Gardner wrote.
This was a political conflict as much as an ideological one. In the 1920s, the medical establishment flexed its growing power by lobbying the Republican-controlled Congress and White House to erode public-health services including school-based nursing, outpatient dispensaries, and centers that provided pre- and postnatal care to mothers and infants. Such services were examples of “socialized medicine,” unnecessary to those who were convinced that diseases could best be addressed by individual doctors treating individual patients.Health care receded from communities and became entrenched in hospitals. Decades later, these changes influenced America’s response to COVID-19. Both the Trump and Biden administrations have described the pandemic in military metaphors. Politicians, physicians, and the public still prioritize biomedical solutions over social ones. Medicine still overpowers public health, which never recovered from being “relegated to a secondary status: less prestigious than clinical medicine [and] less amply financed,” wrote the sociologist Paul Starr. It stayed that way for a century.
During the pandemic, many of the public-health experts who appeared in news reports hailed from wealthy coastal universities, creating a perception of the field as well funded and elite. That perception is false. In the early 1930s, the U.S. was spending just 3.3 cents of every medical dollar on public health, and much of the rest on hospitals, medicines, and private health care. And despite a 90-year span that saw the creation of the CDC, the rise and fall of polio, the emergence of HIV, and relentless calls for more funding, that figure recently stood at … 2.5 cents. Every attempt to boost it eventually receded, and every investment saw an equal and opposite disinvestment. A preparedness fund that was created in 2002 has lost half its budget, accounting for inflation. Zika money was cannibalized from Ebola money. America’s historical modus operandi has been to “give responsibility to the local public-health department but no power, money, or infrastructure to make change,” Ruqaiijah Yearby, a health-law expert at Saint Louis University, told me.
Lisa Macon Harrison, who directs the department that serves Granville and Vance Counties, in North Carolina, told me that to protect her community of 100,000 people from infectious diseases—HIV, sexually transmitted infections, rabies, and more—the state gives her $4,147 a year. That’s 90 times less than what she actually needs. She raises the shortfall herself through grants and local dollars.
Trifling budgets mean smaller staff, which turns mandatory services into optional ones. Public-health workers have to cope with not just infectious diseases but air and water pollution, food safety, maternal and child health, the opioid crisis, and tobacco control. But with local departments having lost 55,000 jobs since the 2008 recession, many had to pause their usual duties to deal with COVID-19. Even then, they didn’t have staff to do the most basic version of contact tracing—calling people up—let alone the ideal form, wherein community health workers help exposed people find food, services, and places to isolate. When vaccines were authorized, departments had to scale back on testing so that overworked staff could focus on getting shots into arms; even that wasn’t enough, and half of states hired armies of consultants to manage the campaign, TheWashington Post reported.
In May, the Biden administration said that it would invest $7.4 billion in recruiting and training public-health workers, creating tens of thousands of jobs. But those new workers would be air-dropped into an infrastructure that is quite literally crumbling. Many public-health departments are housed in buildings that were erected in the 1940s and ’50s, when polio money was abundant; they are now falling apart. “There’s a trash can in the hallway in front of my environmental-health supervisor’s office to catch rain that might come through the ceiling,” Harrison told me. And between their reliance on fax machines and decades-old data systems, “it feels like we’re using a Rubik’s cube and an abacus to do pandemic response,” Harrison added.
Last year, America’s data systems proved to be utterly inadequate for tracking a rapidly spreading virus. Volunteer efforts such as the COVID Tracking Project (launched by The Atlantic) had to fill in for the CDC. Academics created a wide range of models, some of which were misleadingly inaccurate. “For hurricanes, we don’t ask well-intentioned academics to stop their day jobs and tell us where landfall will happen,” the CDC’s Dylan George told me. “We turn to the National Hurricane Center.” Similarly, George hopes that policy makers can eventually turn to the CDC’s newly launched Center for Forecasting and Outbreak Analytics, where he is director of operations. With initial funding of about $200 million, the center aims to accurately track and predict the paths of pathogens, communicate those predictions with nuance, and help leaders make informed decisions quickly.
But public health’s longstanding neglect means that simply making the system fit for purpose is a mammoth undertaking that can’t be accomplished with emergency funds—especially not when those funds go primarily toward biomedical countermeasures. That’s “a welfare scheme for university scientists and big organizations, andit’s not going to trickle down to the West Virginia Department of Health,” Gregg Gonsalves, the health activist and epidemiologist, told me. What the U.S. needs, asseveralreports have recommended and as some senators have proposed, is a stable and protected stream of money that can’t be diverted to the emergency of the day. That would allow health departments to properly rebuild without constantly fearing the wrecking ball of complacency. Biden’s $7.4 billion bolus is a welcome start—but just a start. And though his new pandemic-preparedness plan commits $6.5 billion toward strengthening the U.S. public-health system over the next decade, it might take $4.5 billion a year to actually do the job.
“Nobody should read that plan as the limit of what needs to be done,” Eric Lander, the president’s science adviser, told me. “I have no disagreement that a major effort and very substantial funding are needed,” and, he noted, the administration’s science and technology advisers will be developing a more comprehensive strategy. “But is pandemic preparedness the lens through which to fix public health?” Lander asked. “I think those issues are bigger—they’re everyday problems, and we need to shine a spotlight on them every day.”
But here is public health’s bind: Though it is so fundamental that it can’t (and arguably shouldn’t) be tied to any one type of emergency, emergencies are also the one force that can provide enough urgency to strengthen a system that, under normal circumstances, is allowed to rot. When a doctor saves a patient, that person is grateful.When an epidemiologist prevents someone from catching a virus, that person never knows.Public health “is invisible if successful, which can make it a target for policy makers,” Ruqaiijah Yearby, the health-law expert, told me. And during this pandemic, the target has widened, as overworked and under-resourced officials face aggressive protests. “Our workforce is doing 15-hour days and rather than being glorified, they’re being vilified and threatened with bodily harm and death,” Harrison told me. According to an ongoing investigation by the Associated Press and Kaiser Health News, the U.S. has lost at least 303 state or local public-health leaders since April 2020, many because of burnout and harassment.
Even though 62 percent of Americans believe that pandemic-related restrictions were worth the cost, Republican legislators in 26 states have passed laws that curtail the possibility of quarantines and mask mandates, as Lauren Weber and Anna Maria Barry-Jester of KHN have reported. Supporters characterize these laws as checks on executive power, but several do the opposite, allowing states to block local officials or schools from making decisions to protect their communities. Come the next pandemic (or the next variant), “there’s a real risk that we are going into the worst of all worlds,” Alex Phelan, of Georgetown University, told me. “We’re removing emergency actions without the preventive care that would allow people to protect their own health.” This would be dangerous for any community, let alone those in the U.S. that are structurally vulnerable to infectious disease in ways that are still being ignored.
Biden’s new pandemic plan contains another telling detail about how the U.S. thinks about preparedness. The parts about vaccines and therapeutics contain several detailed and explicit strategies. The part about vulnerable communities is a single bullet point that calls for strategies to be developed.
This isn’t a new bias. In 2008, Philip Blumenshine and his colleagues argued that America’s flu-pandemic plansoverlooked the disproportionate toll that such a disaster would take uponsocially disadvantaged people. Low-income and minority groups would be more exposed to airborne viruses because they’re more likely to live in crowded housing, use public transportation, and hold low-wage jobs that don’t allow them to work from home or take time off when sick. When exposed, they’d be more susceptible to disease because their baseline health is poorer, and they’re less likely to be vaccinated. With less access to health insurance or primary care, they’d die in greater numbers. These predictions all came to passduring the H1N1 swine-flu pandemic of 2009.
When SARS-CoV-2 arrived a decade later, history repeated itself. The new coronavirus disproportionately infected essential workers, who were forced to risk exposure for the sake of their livelihood; killed Pacific Islander, Latino, Indigenous, and Black Americans; and struck people who’d been packed into settings at society’s margins—prisons, nursing homes, meatpacking facilities. “We’ve built a system in which many people are living on the edge, and pandemics prey on those vulnerabilities,” Julia Raifman, a health-policy researcher at Boston University, told me.
Such patterns are not inevitable. “It is very clear, from evidence and history, that robust public-health systems rely on provision of social services,” Eric Reinhart, a political anthropologist and physician at Northwestern University, told me. “That should just be a political given, and it is not. You have Democrats who don’t even say this, let alone Republicans.” America’s ethos of rugged individualism pushes people across the political spectrum to see social vulnerability as a personal failure rather than the consequence of centuries of racist and classist policy, and as a problem for each person to solve on their own rather than a societal responsibility. And America’s biomedical bias fosters the seductive belief that these sorts of social inequities won’t matter if a vaccine can be made quickly enough.
But inequity reduction is not aside quest of pandemic preparedness. It is arguably the central pillar—if not for moral reasons, then for basic epidemiological ones. Infectious diseases can spread, from the vulnerable to the privileged. “Our inequality makes me vulnerable,” Mary Bassett, who studies health equity at Harvard, told me. “And that’s not a necessary feature of our lives. It can be changed.”
“To be ready for the next pandemic, we need to make sure that there’s an even footing in our societal structures,” Seema Mohapatra, a health-law expert at Indiana University, told me. That vision of preparedness is closer to what 19th-century thinkers lobbied for, and what the 20th century swept aside. It means shifting the spotlight away from pathogens themselves and onto the living and working conditions that allow pathogens to flourish. It means measuring preparedness not just in terms of syringes, sequencers, and supply chains but also in terms of paid sick leave, safe public housing, eviction moratoriums, decarceration, food assistance, and universal health care.It means accompanying mandates for social distancing and the like with financial assistance for those who might lose work, or free accommodation where exposed people can quarantine from their family. It means rebuilding the health policies that Reagan began shredding in the 1980s and that later administrations further frayed. It means restoring trust in government and community through public services. “It’s very hard to achieve effective containment when the people you’re working with don’t think you care about them,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me.
In this light, the American Rescue Plan—the $1.9 trillion economic-stimulus bill that Biden signed in March—is secretly a pandemic-preparedness bill. Beyond specifically funding public health, it also includes unemployment insurance, food-stamp benefits, child tax credits, and other policies that are projected to cut the poverty rate for 2021 by a third, and by even more for Black and Hispanic people. These measures aren’t billed as ways of steeling America against future pandemics—but they are. Also on the horizon is a set of recommendations from the COVID-19 Health Equity Task Force, which Biden established on his first full day of office. “The president has told many of us privately, and said publicly, that equity has to be at the heart of what we do in this pandemic,” Vivek Murthy, the surgeon general, told me.
Some of the American Rescue Plan’s measures are temporary, and their future depends on the $3.5 trillion social-policy bill that Democrats are now struggling to pass, drawing opposition from within their own party. “Health equity requires multiple generations of work, and politicians want outcomes that can be achieved in time to be recognized by an electorate,” Planey told me. That electorate is tiring of the pandemic, and of the lessons it revealed.
Last year, “for a moment, we were able to see the invisible infrastructure of society,” Sarah Willen, an anthropologist at the University of Connecticut who studies Americans’ conceptions of health equity, told me. “But that seismic effect has passed.” Socially privileged people now also enjoy the privilege of immunity, while those with low incomes, food insecurity, eviction risk, and jobs in grocery stores and agricultural settings are disproportionately likely to be unvaccinated. Once, they were deemed “essential”; now they’re treated as obstinate annoyances who stand between vaccinated America and a normal life.
The pull of the normal is strong, and our metaphors accentuate it. We describe the pandemic’s course in terms of “waves,” which crest and then collapse to baseline. We bill COVID-19 as a “crisis”—a word that evokes decisive moments and turning points, “and that, whether you want to or not, indexes itself against normality,” Reinhart told me. “The idea that something new can be born out of it is lost,” because people long to claw their way back to a precrisis state, forgetting that the crisis was itself born of those conditions.
Better ideas might come from communities for whom “normal” was something to survive, not revert to. Many Puerto Ricans, for example, face multiple daily crises including violence, poverty, power outages, and storms, Mónica Feliú-Mójer, of the nonprofit Ciencia Puerto Rico, told me. “They’re always preparing,” she said, “and they’ve built support networks and mutual-aid systems to take care of each other.” Over the past year, Ciencia PR has given small grants to local leaders to fortify their communities against COVID-19. While some set up testing and vaccination clinics, others organized food deliveries or educational events. One cleaned up a dilapidated children’s park to create a low-risk outdoor space where people could safely reconnect. Such efforts recognize that resisting pandemics is about solidarity as well as science, Feliú-Mójer told me.
The panic-neglect cycle is not irresistible. Some of the people I spoke with expressed hope that the U.S. can defy it, just not through the obvious means of temporarily increased biomedical funding. Instead, they placed their faith in grassroots activists who are pushing for fair labor policies, better housing, health-care access, and other issues of social equity. Such people would probably never think of their work as a way of buffering against a pandemic, but it very much is—and against other health problems, natural disasters, and climate change besides. These threats are varied, but they all wreak their effects on the same society. And that society can be as susceptible as it allows itself to be.“
