What Just Happened and What Does it Mean for Health Care?  

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

Catherine:

… at Politico. In this role, she has led an expansion of its healthcare coverage, tripling the size of the team. Joanne continues to write for Politico, Politico Magazine, and the Agenda. She also regularly appears on KHN’s What The Health? Podcast. Joanne, thank so much for joining us. I’m so glad to be leaving this discussion in your very expert hands.

Joanne Kenen:

Thank you. Thank you, everybody who is joining us. We’re going to talk about the election results, and what it might mean for healthcare. I have two esteemed experts. They’re both familiar to you. Robert Blendon is the Richard L. Menschel Professor and Senior Associate Dean for Policy Translation and Leadership Development at Harvard T.H. Chan School of Public Health. I think he’s now emeritus in some of his roles.

Joanne Kenen:

He also directs the Harvard Opinion Research program, which focuses on garnering a better understanding of public health knowledge, attitudes, and beliefs about healthcare and other major policy issues. And he’s somebody who’s taught me a lot about how to think about healthcare and politics.

Joanne Kenen:

We also have Liz Hamel. She’s the Vice President and Director of Public Opinion and Survey Research at the Henry J. Kaiser Family Foundation. She directs KFF’s polling work, including the monthly health tracking poll that lands in all of your inboxes every month. Thank you for joining us. Bob, let’s start with you. We’ll have some slides, I believe.

Robert Blendon:

In a moment. It’s terrific to appear, both with Joanne and Liz. What I want to try to do briefly is do a weather forecast of the next year and a half, with a lot of humility. As you know, the weather forecast has not been particularly good, and the polling ones have not been much better.

Robert Blendon:

So for this, and I want you to understand two stories that have appeared front page in the media since the election results are mostly over. One said that the new administration will lead sweeping changes in health and health policy. And then the next day, you pick up the paper and it says, “President faces serious gridlock challenges with Congress. Little of significance will happen.”

Robert Blendon:

And I want to explain to you, over the next year and a half, how both those headlines are correct. And I want to explain what’s actually happened in the country, how it affects the election results, and how it’s going to affect health policy. So, since the 1990s, the mid-1990s, what’s happened in this country, if you survey people on simple questions: “What do you want the federal government to do to solve the big problems facing the country?”

Robert Blendon:

People who said they were Republican and Democrat in 1994 were this far apart. They were not together. Please, let’s not pretend there was another America. But they were that far apart. Now, they’re that far apart. It’s doubled since 1994. And the answer to the simple questions, “What do you want the federal government to do about this?” And this would all be interesting, except one other thing happened that, if you’re in healthcare, you often don’t pay a lot of attention to.

Robert Blendon:

The parties really became different. So, if I’m a Republican and I ask you one other question, “How do you see yourself politically?” 72% say, “I’m a political conservative.” If you’re a Democrat and I just say, “I just want to know. Give me one answer. How do you see yourself politically?” If 53% now say, “I’m a political liberal, or in the modern term, progressive,” for that.

Robert Blendon:

And so, what happened is not only the switch, but people decided that if they were Republican or Democrat, that you could only vote in primaries if you’re one or the other. I don’t want a senator or congressman that doesn’t reflect my views. So, since the mid-1990s, if you’ve noticed, we’ve been challenging Republicans and Democrats who were incumbents. And conservatives have been winning on one side, and more and more liberals and progressives on the other.

Robert Blendon:

Massachusetts just had a major election between two Democrats for that, which was decided in the primary. But really, there was no Republican opposition. And so, where that leads is that, and I’m very sympathetic because I’m part of this other world, if you want to predict what the Congress is going to do, and I’m going to focus on that most, you have to understand that in today’s world, the Congress follows the majority of the party views, not all of the public.

Robert Blendon:

And it’s overwhelmingly significant. A whole group of political scientists have published papers which study the votes of members of the Congress, and show it doesn’t correlate with public opinion. It correlates with the Republican or Democratic opinion, whosever in the majority.

Robert Blendon:

So, what’s important to understand, and we have not settled this yet, though we’re fighting when the president’s going to turn over the advisory authority to President Elect Biden, the Senate isn’t fully settled. There are two Senate seats that are up in Georgia, that will be voted on in January for that.

Robert Blendon:

If the Republicans win one, they are in the majority. Every chair of every committee is Republican, and the policies will reflect that. The Democrats, if they were to win both, would just have an edge in the Senate. But I need to make this point very clearly, and then I’ll show you why it really matters.

Robert Blendon:

Republican senators were not elected in this election to help President Elect Biden implement his health agenda. Question after question. “No. No. That’s not what I want to do. That’s not where I want to go.” So, if I am Mitch McConnell and I am chair of the Senate Finance Committee and the Health Committee, and I am a Republican, I did not get elected. And if I have a primary challenge, those primary challengers are going to hold me to what it means to be a Republican, and in the House, a Democrat.

Robert Blendon:

So quickly, just so you see this, what does this mean in real life? So, after the death of Supreme Court Justice Ginsberg, the question was, “Do you fill the seat before the election’s over?” The poll results said 57% of Americans said, “Wait.” But if you look very carefully, 80% of Republicans said, “Fill it.”

Robert Blendon:

Well, if you know what happened, the Republican leadership didn’t wait two hours to fill that job. Just to be bipartisan here, understand that when the ACA was enacted, the majority of Americans told pollsters they didn’t want it enacted. The majority did not favor it.

Robert Blendon:

The majority of Democrats overwhelmingly favored it. It passed closely. But the Democratic leadership with both houses did not wait for majority opinion. And so if you want to look at what’s going to happen over the next year and a half, two things can happen. And I’m going to actually drag Joanne into this, because Politico is more of an expert in this than I am.

Robert Blendon:

We have left the Presidency with unbelievable executive powers in this country. I don’t think many people realize, over the last decade, how many things the President can do without calling the Congress. So, day one, we’ll be back in WHO. Day two, we’re going to back in the Paris Agreement. No Congress, none of this. Wake up, the head of WHO will be sipping Coke with the President for that.

Robert Blendon:

And so, there are a whole series of issues, which I hope Joanne’ll cover, where you can expand the ACA. You can enter into some price negotiations. You can change the environment for Medicaid. You could use demonstrations, which look like you’ve changed the law, except they’re called a “research demonstration,” which requires that they have to hire Liz or Bob to come by and bless them every six months, “Oh, we’re studying how all of Oklahoma’s going to change its payment system.”

Robert Blendon:

So, there are dramatic things the President can do, and I’m going to leave you with questions in a moment. I’ll hit the issues, but will not solve, but I want to you show one slide. And the minute you move your eyes from “all” to “Republicans” and “Democrats,” you see exactly what the climate’s going to be.

Robert Blendon:

So just, “Do you favor universal coverage or not?” You notice that the professor doesn’t spend any time looking at “all.” Republicans, no. Democrats, overwhelmingly. So, just tell me who’s in charge and I’ll tell you in the Congress. Okay, big health reform. “Do you favor expanding and improving the ACA?” 24% of Republicans, 89% of Democrats.

Robert Blendon:

How about Medicare for All, whatever that turns out to be? 24% of Republicans and 63% of Democrats. How about expanding Medicaid to really cover more people and pay for more services? 25% of Republicans, 63% of Democrats. We’re going to talk about COVID and the question period. Who should be in charge of really running and making the decisions? Who closes you down? Who says if you have …

Robert Blendon:

Republicans want state and local officials to lead. Not Democrats. They want the President to have mask mandates and everything else, right out of Washington. Also, just so I can show you what the pictures will be that’ll change, Republicans and Democrats differ in their trust in medical scientists in the public interest.

Robert Blendon:

And so, you’re going to go from President Trump leaving at some date to President Biden, and you’re going to find the Oval Office surrounding with white coat scientists. It’s going to look like Grand Rounds at the NJH. President Biden is going to say, “I’m credible because Dr. [inaudible 00:10:54] that scientists from that flying in or advising me.”

Robert Blendon:

There was no white coats surrounding the President before that. And so, we’re going to see a shift. And so, in the period when we open up, I can answer questions about what it might mean for universal coverage, COVID, race and disparities. And I will just make this point and then we’ll go back to it later. Basically, even though there are conflicts in the Senate, basically President Biden would not have gotten the nomination without Black voters. You have to understand this.

Robert Blendon:

It’s totally different than public views. He went into South Carolina as somebody who was going to teach at Harvard when he was through, and he left South Carolina as the absolute winner, and went through the South, primary after primary, and why did he win? It was Black voters.

Robert Blendon:

And so, this administration and every act that it takes, with or without the Congress, is going to enter an oversight regulation focus on race and health and disparities. And it’s not just the policy. It is that this is downright politics. The President is there because of Black voters.

Robert Blendon:

We’ll hit drug prices. We’ll hit gun control, and then I just want to make one other point. Many state and major cities next year are going to have horrendous deficits, and somebody just put out a chart. It’s slightly better, but the deficits will be very large.

Robert Blendon:

They’ve been borrowing from this, and while we’re talking about how Democrats are going to expand spending in 54 different areas, you’re going to discover cities without help, laying off teachers, laying off public health people, cutting back mental health services, unless the Congress and the President give special emergency aid to states and local governments.

Robert Blendon:

This is going to be an incredible, controversial area, and very hard for the public to understand because Biden talked about trillions for this and trillions of this, and why is New York City laying off people? So, let me quick turn it over to Liz, and we can take questions on every issue of how this will play out. But the point I just want to leave you with, polarization has led, if it’s Republican Senate, to be in a very different place than people who voted for the President Elect.

Joanne Kenen:

Liz, why don’t you give us your overview and then we will follow up on some of these questions.

Liz Hamel:

Great, thanks. And I do have a few slides. Thanks for that, Bob. It sounds like we have a lot to tackle, and I’m going to show a few more data points. I’m more of a visual person, so I do have a few charts. But I promise to keep it brief, and I look forward to getting on with our discussion. So, if we can have the first slide?

Liz Hamel:

Just looking back at what has happened over the last several election cycles, healthcare has been an important issue to voters, and that’s mainly been centered around the passage, implementation, and calls to repeal the ACA. We saw in the 2018 midterms after the failed attempt at repealing and replacing the ACA, that the issue of preexisting condition protections became a dominant theme in the midterm election advertising in 2018.

Liz Hamel:

And early in the 2020 election cycle, our KFF polling back in February found that healthcare and the economy were the top two issues that voters said would be most important to their vote for president. If you think back, this was during the Democratic Primary debates, and it seemed like everything we were hearing about was Bernie Sanders’ Medicare For All plan. Are you going to be able to keep your private insurance?

Liz Hamel:

That all seems like ancient history now by October, following the rise of the pandemic, the economic crisis, the summer of protests over racial justice. When we asked voters in October about the most important issue in their vote for president, you see healthcare sort of fell down the list, and was a second tier issue among some of these other issues.

Liz Hamel:

Obviously, this is a little bit of an oversimplification. These issues are overlapping. The pandemic is a healthcare issue, and with the focus on rising costs, healthcare is also tied up with the economy. But certainly, the healthcare issues being discussed in the campaign in October were a far cry from those being discussed in February.

Liz Hamel:

If we can go to the next slide, I just need to say that, issues aside, we have lots of data points showing that the presidential race was largely a referendum on Donald Trump. So, during the Democratic Primary, more voters said they’d prefer a candidate who could defeat Donald Trump than someone that agreed with them on the issues.

Liz Hamel:

I don’t know if that next slide is coming up yet, but I have some data from the AP VoteCast survey of voters, and you can see that President Trump was the dominant factor in the election. About half of Biden voters said their vote was mainly against the President. About eight in 10 of Trump supporters say their vote was in support of him.

Liz Hamel:

I’m not seeing the slides moving, but I’ll go on and talk about the data points on my third slide. That’s the second one. If we can move to the third one? However, just because it’s a crowded issue environment, and just because Trump was a dominant factor in the election, it doesn’t mean that voters don’t care about healthcare.

Liz Hamel:

We asked voters in October about a variety of different healthcare issues, and how important each one would be for their vote. You can see them here, and you can see that a big majority say that all of these issues are at least somewhat important, and majority say many of them are very important, with protections for preexisting conditions at the top of the list.

Liz Hamel:

So, voters may not be making their voting decisions based on the details of candidates’ health plans, but they do care about healthcare. They want to hear candidates talking about it and making them feel like their concerns are heard. And this is one reason why we hear candidates on both sides of the aisle talking about protecting people with preexisting conditions, even if the details of their plans or lack thereof couldn’t really be further apart.

Liz Hamel:

On the next slide, Bob showed some of the deep political chasms between Republicans and Democrats on questions of healthcare policy. This is true in a broader sense as well, particularly when it comes to the pandemic. Here’s one example from the AP VoteCast survey. You can see that a majority of voters said it’s more important for the government to limit the spread of coronavirus even if it damages the economy. About four in 10 said the reverse.

Liz Hamel:

But look at the big divide. 89% of Biden voters saying it’s more important to limit the spread of the virus, 71% of Trump voters saying the other thing. This kind of echoes what we see across our KFF polling work. Over the course of the spring and the summer, those partisan divides on questions about the virus, everything from mask-wearing, personal risk perception, trust in public health officials, those divides grew over time.

Liz Hamel:

And it highlights a massive challenge for the Biden team when they take office. They need to combat rampant misperceptions, repair public’s trust in public health agencies, and perhaps most importantly, they need to try to convince people it’s not a trade-off between dealing with the economy and dealing with the virus. You need to control the virus in order to get the economy back.

Liz Hamel:

Finally, just one slide highlighting one more challenge for the incoming administration. It’s especially timely given the positive vaccine news we’ve heard over the past week. For a vaccine to be really successful, we’re going to need people to take it. Multiple surveys have shown a decrease over time in the share saying that they would take a vaccine, although I saw a Gallop release this morning that, in their data at least, it was bouncing back up a little, and that was from data before the election.

Liz Hamel:

We’ll see what happens now that we have some news of an actual vaccine, but what we have seen in our polling and others is that there are two groups that are more hesitant to take a vaccine. One is Republicans who are less likely to think the virus is a big deal. But perhaps more concerning, among Black adults, this is a group that’s been disproportionately impacted by the pandemic, they’re less likely than White or Hispanic adults to say they’d be willing to get vaccinated.

Liz Hamel:

And this isn’t because of a lack of concern about the virus, but it really reflects a distrust of the medical system and concerns about racism and mistreatment that have been persistent in the Black community. So, besides political divisions, this is another challenge ahead for the incoming administration. So, that’s all my data. I look forward to squeezing in a discussion of all these interesting points.

Joanne Kenen:

Okay. As we converse, I’m going to work in some of the audience questions at the same time. These are two related questions. We’ve gone from a country that Bob said we were this divided, to further than you can reach divided. Does that mean we’re in for a period of complete and total whiplash? Every four years, our national policies are just going to go … And also, what is the role of independents? Are people really independent, or are they really a party member or consistent voter in one party, but they like to say they’re independent?

Robert Blendon:

So, briefly, first, independents are wonderful, except they don’t vote in primaries. They also give less contributions. They also don’t man booths to get people to turn out the vote. And so, as more and more people enter primaries with very strong opinions, there are a lot of people who are in retirement because they said, “My campaign is running for the independents.”

Robert Blendon:

It turns out if you can’t get the nomination, you’re not going to get that. So, there is more and more … Yes, in the two weeks before the election, “What can I do to appeal to independents?” But to not have a primary challenge, to have to spend $50 million with somebody in my primary is saying, “I am hugging one party or the other.” We’re not leaving that period at the moment.

Robert Blendon:

Secondly, I am very guilty. I warn everybody, “Please do not attend sessions that say, ‘What is healthcare going to be 10 years from now?'” Because of this political polarization, we are going to back and forth. Just remind people historically, Clinton won and [inaudible 00:21:48] “This is the new era, everything else.” Two years later, he lost the House and Senate.

Robert Blendon:

Obama wins, “It is the future direction and the ACA is going to set everything …” He lost the House and Senate in two years. President Trump was going to change healthcare and regulation. He lost the House in two, for that. And we are likely to see huge variations for it.

Robert Blendon:

And something that’s very important, that I didn’t hit. Republicans, if they could ever get their act together, have a preference for state policy making. And in their world, if they could agree … and simply, the reason why they can’t come up with a policy, is that they have half Republicans who don’t think you should do anything around universal, large-scale coverage.

Robert Blendon:

You have the other who think you can’t get away with it, Richard Nixon’s view, without doing something, but it should be run by states. And so, Republicans, to a degree, that are in authority, are going to try to push whatever exists into the more private sector and into the states. So, I do believe we’re going to have cycles for at least a decade, and it’s really going to matter. And I love independents, and if you can catch a primary, it would be really helpful.

Joanne Kenen:

One of the things that’s been interesting, and maybe underappreciated, as we’ve had these bigger and bigger chasms over healthcare, to the point that even a pandemic is politicized, right? We can’t even agree on basic science. There’s also been a big shift in that, even though we don’t believe as a country, we really haven’t come to an agreement that healthcare is a human right or a basic right, we do believe in covering preexisting conditions now. That’s across the board.

Joanne Kenen:

Trump didn’t actually come up with a policy that would do it. I mean, he has an executive order saying it would be really nice, but there isn’t an actual Republican plan to do it. But at the same time, the ACA has survived and taken root in ways … I mean, even the Supreme Court was surprisingly … They’re not usually that clear about what they’re going to do, and they’re not going to throw it out.

Joanne Kenen:

So, are you seeing any polling data, either of any emerging other areas that may be a surprising agreement? Or what does this preexisting condition consensus say about maybe being able to not have whiplash on everything, and that some things do settle down?

Liz Hamel:

Yeah. I think one of the things about the preexisting condition issue is that it just really touches a lot of people. When we ask people, you can look at estimates of how many people actually have conditions that would have been deniable prior to the ACA, but if you ask people, “If you or someone in your household has a condition that would be considered a preexisting condition,” we get a majority saying, “Yes.”

Liz Hamel:

But voters are not going to look at the details of a plan to decide if it really is going to protect preexisting conditions. President Trump just had to say that he was going to do it, and his constituents, his base believed that he would. I think if we look at other issues where there’s consensus among the public, and we might see some movement in Congress, it’s surprise medical bills and prescription drugs.

Liz Hamel:

I think we said, after 2018, those were probably the two areas where Congress could do something. We saw maybe a little bit happening on prescription drug, but I think now, given a divided Congress and administration, I think those are still the two areas, and certainly areas where the public wants to see action.

Liz Hamel:

We know that surprise medical bills are a big source of economic anxiety for people, and prescription drug costs are something, when we ask about varieties of ways to lower prescription drug costs, you get 80% of the public saying, “Yes, this sounds like a good idea.” So, I think those are probably the two areas where we could see something happen.

Joanne Kenen:

I’ve had some questions, and there’s obviously been a lot of discussion. I know Bob feels really strongly about not analyzing what went wrong the political polls until we know that researchers are looking at it, and we know it’s going to take a while to figure it out. There’s a second kind of poll when you’re polling on public policy or you’re polling on issues. Do we know if … Liz, what role do they still have, and can we still count on them? Because the electoral ones …

Liz Hamel:

Yeah. It’s a crisis for those of us who do issue polling every time we have an election, because the expectations for how accurate those election prediction polls are going to be, and when we’re so closely divided, it’s inevitable you’re going to have some misses.

Liz Hamel:

Some of those problems are particular to trying to figure out … When you’re doing election polling, you have to guess who your popUlation is going to be. The type of polling where we’re doing of the general public, we know what the general public is. We know what the demographic are and how to weight the data, so we’re not dealing … Some of the problems facing election polling still face our field.

Liz Hamel:

We’ve had declining response rates. We have ways to deal with that, but if there is a systematic non-response from conservatives, that will affect our issue polling as well. But it’s not quite as much of a challenge for us as it is for the polling that’s trying to predict elections.

Joanne Kenen:

Does the public like … I mean, we know they like being divided because they vote for extreme … Well, people who vote in primaries tend to be more at the extremes of their party, and that distorts who ends up getting on the ballot. But do we know whether people really like this sense of division we have?

Joanne Kenen:

We look at it and we say, “Oh, they’re so divided.” Do you have any sense of people thinking, “Hey, it’s time that we start coming together”? Or are there … I mean, we know what Twitter’s like, but that’s not the real world. I referred to “President Elect Biden” in a tweet, and I got, “Ah, he’s not President!” Blah, blah. But does the country look at themselves the way we look at the country?

Robert Blendon:

Yes and no. So, as a whole, the general public would like the country to come together. The problem is in actual behavior. It’s just like, “Are you worried about obesity?” “I am.” “What are you getting for your children’s Thanksgiving?” “Well, of course, I’m getting cakes and I’m getting ice cream and blah, blah, blah.”

Robert Blendon:

So, the people who choose to vote in primaries are people who feel very strongly that their candidate represent them. And so, they’re not against if the other party wants to shift their view, but they feel very strongly that they want their candidates … and if you look at the challengers to Democrats recently, “Yes, let’s bring America together, as a progressive.”

Robert Blendon:

They’re not interested in saying, “No, I’m going to throw out my views about the Green New Deal and this, so we can all be together and do moderate policies.” So in reality, people who vote and elect have very strong feelings that they want their candidate to represent their view.

Robert Blendon:

So, there are lots of nonpartisan issues. And we identified some, and opioid abuse. There’s others and the NHS is for that, where people don’t want to do it. But basically, the strength of opinion of people who are politically active in their party has increased, not decreased, for that.

Robert Blendon:

And what Pew has shown is that people who are attached to their party have decided, socially, they don’t like people from the other party. There’s actually a poll that says, “I won’t date somebody who is either for or against Trump. I really don’t like to talk at family matters about politics, because I disagree with it.”

Robert Blendon:

That’s not a sign of, “Let’s all come together.” If you can’t get your family around the table to feel comfortable about talking about this, I don’t see the Congress for that. So, we’re going to be in a period, I believe, where we are going to have sharp divisions.

Robert Blendon:

And the question is to find issues and approaches to policies that can move, but also back to … I’m going to get this to you again, President Biden’s got to go walk in the White House and say, “Give me 80 things I can do by executive order. I’ve had enough having dinner at the Senate. Well, it used to be a wonderful place and John McCain hugged me and it was great. Not so much anymore. So, give me 80 things I can do and not have to go visit the Senate.” That’s your job, Joanne.

Joanne Kenen:

I think it’s … Well, very briefly, I think we should remember that President Trump ran on repeal and replace. And not only did he run repeal and replace, he said he was going to do it on day one, right? He was going to call a special session of Congress and all that. And Congress spent a year huffing and puffing, and they did not blow it down.

Joanne Kenen:

But that doesn’t mean he didn’t have an imprint on the ACA. He had a big imprint on the ACA, and a big imprint on Medicaid. And there’s some things Biden can do really easily. Some executive acts would be easy, should he choose to do them. Some are going to be more difficult, more contentious, and would end up in court.

Joanne Kenen:

One really easy thing he could do is, Trump didn’t do a lot of outreach on the ACA. He cut back the navigator budget. He cut back outreach. I think a lot of the country doesn’t even know right now that AC enrollment is … You don’t even see anything about it. It’s six weeks. We’re already partway through it. We’ve got one more month. It’s coming in.

Joanne Kenen:

The early numbers, that it’s low. Biden could do … This season will be over before he takes office, but it’s under his power to create a special enrollment period, or to change the dates. And certainly, just talking about it, restoring the navigator. There’s a lot of things he could do right there.

Joanne Kenen:

He can’t get the public auction through the Senate. He can’t get Medicare age changes through the Senate. He could probably do an awful lot to strengthen the ACA because there’s need out there. We don’t know how much many millions, but we know millions of people lost their jobs. Many, we’re not sure how many, lost their insurance as well.

Joanne Kenen:

There’s clearly uninsured people there, who were insured before the pandemic. So, I think that’s one area you could see. But I actually wanted to ask you both about the issue of trust. One thing that really struck me … We are so divided. I mean, masks are a political symbol, not a healthcare item, right?

Joanne Kenen:

Right after the election, we surveyed the governors who didn’t have mask mandates. And it was, “Hell no.” Right? It was like, “We’re not going to do that.” People were personally responsible, et cetera. In the last 10 days or so, four Republican … I think it’s four Republican governors, since the election, have either instituted a mask mandate, or strengthened a narrow one that they had.

Joanne Kenen:

So, when the tone changes at the top on public health, not on some of the things that have been contentious for years, but the tone changing at the top from Biden, combined with the fact that this virus is so everywhere now. There’s no part of the country that is not affected. The death rate is going up. The death toll is going up. We’re seeing a million cases a week a state now.

Joanne Kenen:

Is that going to change? At least, can we take baby steps toward trust in public health? And that’s probably my last question for the two of you. Think about that, or what is the area? If it’s not masks, if it’s not a virus, is there an area that we can begin to build, even if it’s unusual partnerships, to begin to restore … You’re not going to restore trust in this country. You’re not going to restore unity in this country in an inaugural speech. But are we seeing any kind of window now? Liz, do you want to start?

Liz Hamel:

Yeah. I will say, I did see one poll come out this morning from Axios and Ipsos that showed that Republicans were starting to take the virus more seriously, and this probably reflects those huge case load increases we’re seeing in rural areas and parts of the country that hadn’t previously had it.

Liz Hamel:

So I think when it hits home from people, they are going to take it more seriously. Of course, there were still big divides. But I think, to your point, I think we will see Republican leadership taking those steps when it’s not just rhetoric, when it really is about protecting lives in your state. I think we will see that, and I think we’ll probably see it among the public as well. It may never be completely … You won’t get rid of the divide completely, but it could change a little bit. And yeah, I think we only have a few minutes, so I’ll let Bob respond as well.

Joanne Kenen:

Have you ever seen anything in public health as divisive as this in your long polling career?

Robert Blendon:

So, first of all, we’ve had a national tragedy. This occurred around an election. And so, if it wasn’t around an election, I believe it would have been framed, as we do with a level five hurricane. It’s a natural, national disaster, of which Republicans and Democrats rally for [inaudible 00:35:21] or the fires, wildfires in California. For that, years ago, when we studied hurricanes, we asked who people trusted, it was head of the National Guard, about whether or not they should evacuate, or not.

Robert Blendon:

People, if they get in their heads, it’s a natural disaster. It’s something like we never had before. We got to deal with this, they tend to trust experts and authority figures around the natural disaster. But this got to be framed as whether or not you’re for the economy, or you’re for experts closing down their lives. And that is a terrible frame, and it entered the political stream in a way that other natural disasters just don’t, for that, and so we’re going to have to just try to escape the political frame.

Robert Blendon:

My God, when the hurricanes hit, you got to go to a shelter. “No, I’m against shelters because I’m conservative.” It’s absurd. Of course you’re for shelters. Conservative or liberal, you want to save people’s lives. Get off this. And church groups are running in, “We got to do all these things.”

Robert Blendon:

And this has got caught in this election, in a very vicious partisan election for that. So it’s going to be tough to get that. At the second time, I think if you just look at these surveys and over again, and the public health people are getting a little sensitive, and they surely are in Europe, closing down people’s livelihoods has a very significant impact.

Robert Blendon:

Wearing a mask does not. It annoys libertarians. It does not alter your livelihood, your kids’ chance to go to college. And so, if you watch Europe, these prime ministers are trying to say, “I have to moderate this. I have to find a way that we control some of this, but I can’t go back to telling you that the meat industry doesn’t open for that.”

Robert Blendon:

So we’re going to have a period here of trying to find some way that we stop this virus until the vaccine, or doesn’t have an impact, without having the type of economic impact we did. So, the president will rely more on experts. But even, I’ve noticed, some of the experts have said, “We have to be much more precise. We can’t just close the economy.” They have learned that there is a practical implication of saying that, “We’re not going to have anything for that.” But we suffer from this having this occur in the middle of an election. It’s just awful.

Joanne Kenen:

Well, we are just about out of time. I could talk to the two of them forever, but there’s another session coming up. So, thank you for joining us today, and Catherine is going to tell you about how to move on to the next session.

Catherine:

Right. Thank you, Joanne.

Robert Blendon:

Liz, Joanne, take care.

Catherine:

Yeah. Thanks, Bob. Thanks, Liz. Thanks, Joanne. Great way to kick us off, and in the vein of polling, we also want to make sure our programming involves our community, so please take time to complete the brief evaluation survey that you’ll receive immediately after the broadcast ends, as well as via email later today.

Catherine:

And I encourage you to join us again for our other sessions, especially for one that’s happening in the next 15 minutes. And you should have a second Zoom link to join that second session. Thank you so much, and see you on the next one.

Catherine:

(silence)

Lori Reilly:

As we look at healthcare in 2021, one thing is certain: We need to beat COVID-19. PhRMA member companies are working around the clock to develop therapeutics and vaccines to treat and prevent this disease. We’ve seen some great news on their efforts in the recent days and weeks, and our early success is helping us move forward in our fight against COVID-19.

Lori Reilly:

We look ahead to 2021, we also to address patient out-of-pocket costs. In response to COVID-19, Americans have a renewed sense of unease around both the quality and cost of their healthcare. In fact, a recent poll showed nearly 60% of voters worry they don’t have adequate coverage needed in the case of a major medical event.

Lori Reilly:

There is an urgent need and desire for policies that ensure fairness, access and affordability, while also maintaining healthcare choice and quality. We stand ready to help in that effort, promoting policies that would lower what patients pay at the pharmacy counter, like capping out-of-pocket costs and deductibles, and allowing patients to smooth their costs over the course of the calendar year.

Lori Reilly:

Next year, PhRMA will continue to work with policy makers and regulators to put COVID-19 behind us, to advance policies that lower what patients pay, and to sustain and protect a robust innovation ecosystem that makes it develop new medicines. Thank you. As we look at healthcare …

Peter Leibold:

Hi, my name’s Peter Leibold. And on behalf of Ascension, and as a board member of the Alliance for Health Policy, I want to thank the Alliance for sponsoring and organizing this important discussion around health policy in 2021 and beyond. An important part of Ascension’s mission is to advocate for a more just and compassionate society through our actions and our words.

Peter Leibold:

We have done since our founding, and we will continue to do so in the years ahead. For that reason, we strongly supported the enactment of the Affordable Care Act. In 2021, and in the years beyond that, we will continue to advocate for policy changes designed to improve and expand the reach of the Affordable Care Act.

Peter Leibold:

In 2021, we will also advocate for continued financial and regulatory relief for hospitals and clinicians on the front lines of struggling with the COVID-19 pandemic. We will provide suggestions to improve emergency management and coordination to prepare us for the next pandemic or emergency.

Peter Leibold:

We will support efforts to expand and accelerate the tremendous progress we have made on virtual care, and we will engage in dialogue with the Hill and with the administration, so that we can provide care consistent with our values and our mission. So, thank you for allowing us to support and sponsor this particular dialogue, and thank you to the Alliance for promoting it.

Kelly Appenzeller:

Hi, everyone. This is Kelly Appenzeller with the Alliance for Health Policy. If you are still logged into this Zoom session, please close out of this Zoom window and make sure that you open the link that you received via Zoom roughly one hour ago for the session two link. This session will now end. If you need to, you can re-register at our website for panel two, or please look in your email for a message from Zoom about session two, and the link to access there. Thank you, and we will see you shortly.