Trump: We’ll Spend ‘Whatever Is Appropriate’ to Fight Coronavirus

Plus: Trump's history of CDC cuts By Yuval Rosenberg and Michael Rainey Trump: We’ll Spend ‘Whatever Is Appropriate’ to Fight Coronavirus President Trump on Wednesday evening defended his administration’s preparedness for the new coronavirus, saying that Vice President Mike Pence will be his point person leading the federal response to the outbreak. Trump said that the risk to the American public remains low and that he is willing to spend more than the $2.5 billion in emergency funding the White House requested from Congress this week. “We were asking for $2.5 billion, and we think that’s a lot,” Trump said at a news conference. “But the Democrats and I guess Senator Schumer wants us to have much more than that. Normally in life, I’d say, ‘We’ll take it, we’ll take it.’ If they want to give more, we’ll do more. We’re going to spend whatever is appropriate. Hopefully, we’re not going to have to spend so much because we really think we’ve done a great job in keeping it down to a minimum.” The administration asked Congress for [$1.25 billion in new funding]( to deal with the coronavirus and proposed to redirect about the same amount from other programs, bringing total funding in its proposal to at least $2.5 billion. Lawmakers in both parties quickly questioned whether that would be sufficient. Here are other developments on the federal response to the virus: Azar says administration may seek more money: Facing a second day of tough questioning by lawmakers, Health and Human Services Secretary Alex Azar told a House panel Wednesday that the administration is planning to spend “at least” the $2.5 billion it laid out in its plan this week and would work with Congress to determine an appropriate figure. Lawmakers look to boost emergency funding: Bipartisan congressional negotiations on funding for the coronavirus response began Wednesday, according to The Wall Street Journal, as lawmakers from both parties continued to criticize the White House request as inadequate. House Speaker Nancy Pelosi called the administration’s plan “meager” and “anemic,” while House Minority Leader Kevin McCarthy called the White House’s request for $1.25 billion in new funding “a little low” and said he expected that about $4 billion would be necessary, according to [Bloomberg](. Schumer proposes $8.5 billion in emergency funds: Senate Democratic Leader Chuck Schumer called for [$8.5 billion]( in emergency funding to combat the virus. Schumer’s proposal includes $3 billion for a public health emergency fund, $1.5 billion for the Centers for Disease Control and Prevention, $2 billion to reimburse state and local governments for their efforts, $1 billion for rapid vaccine development and $1 billion for the U.S. Agency for International Development to deal with emerging health threats. Schumer’s office reportedly noted that Congress appropriated more than $6 billion for a 2006 flu pandemic and more than $7 billion for the H1N1 swine flu outbreak in 2009. Democratic candidates slam Trump’s pandemic preparedness: At Tuesday night’s Democratic presidential primary debate, Joe Biden, Michael Bloomberg and Amy Klobuchar all attacked the Trump administration, criticizing the president’s removal of global health experts from his national security team and his proposed cuts in funding to the Centers for Disease Control and Prevention (for more on that, see below). “What's really happening here is the president fired the pandemic specialists in this country two years ago. So there's nobody here to figure out what the hell we should be doing,” Bloomberg said. Last week, 27 senators sent a [letter]( to national security adviser Robert O’Brien, asking him “to appoint a qualified, dedicated, senior global health security expert” to the National Security Council. What Trump Has Tried to Do to CDC Infectious Disease Funding President Trump “has consistently proposed funding cuts to the Centers for Disease Control and Prevention. But Congress has consistently overruled him,” [Kaiser Health News and PolitiFact]( report. The White House budget request for fiscal year 2021 reportedly would cut the CDC budget by [almost 16%]( and the Health and Human Services Department’s by nearly 10%. Here’s Kaiser Health News’s rundown of the administration’s history of proposals for the CDC’s emerging and zoonotic infectious diseases programs specifically: “The Trump administration’s initial budget proposal has consistently been lower than what was spent the previous year. The administration proposed $61.7 million less in 2018 than 2017; $96.4 million less in 2019 than in 2018; $114.4 million less in 2020 than in 2019; and $85.3 million less in 2021 than 2020. “However, Congress usually treats any president’s budget proposal as an opening volley, with lawmakers reshaping the federal budget as they see fit when they craft final spending bills. “Every year since Trump has been president, lawmakers have passed bills — bills that were eventually signed by the president — that not only exceeded what Trump had asked for on emerging infections but also exceeded what had been spent the previous year.” Fact Checking Sanders’ Latest Claims About Medicare for All Bernie Sanders’ Medicare-for-All proposal once again came under attack in Tuesday’s Democratic debate. In defense of his plan, the senator from Vermont cited a recent analysis in the British journal The Lancet that found that Medicare for all will lower health care costs by $450 billion a year and save 68,000 lives. Sanders’ description of the Lancet analysis, which we summarized [last week]( was accurate as far as it goes, but health care experts have raised numerous questions about the reliability of the analysis itself. Here are some of the problems with the study, which was co-written by a former unpaid Sanders adviser, that critics are talking about: - Utilization: The Lancet study assumes that Medicare for All will increase the level of demand for medical care, but only among the 24% of the population that is currently uninsured or underinsured. Most health care experts, however, say that the plan’s elimination of cost sharing, along with a more generous set of benefits, will likely produce a much larger increase in overall demand as people seek care without fear of incurring big medical bills — and that higher demand needs to be incorporated into the cost estimate. - Payment rates: The study assumes that Medicare payment rates would be rolled out across the entire health care system — a reasonable assumption for a theoretical analysis, perhaps, but probably not so realistic, given the political power of the groups involved. Few experts believe that it will be possible to force doctors and hospitals to accept Medicare rates, which typically are significantly lower than the rates currently paid by private health insurance. Once payment rates approach more realistic levels — it’s hard to say exactly what those levels would be, except that they would be higher — a good portion of the savings in the Medicare-for-All system are eliminated. - Administrative costs: Overhead costs in the current Medicare system equal 2.2% of total spending, much lower than the private insurance overhead rate of 12.4%. The study assumes Sanders’ proposed system would bring administrative costs down to current Medicare levels, but many experts doubt that overhead costs could go that low. “While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals,” Shefali Luthra of Kaiser Health News [said]( in her fact-check of the study. - Lives saved: While it’s reasonable to assume that making health care more accessible would save lives, the number in the Lancet study — 68,531 deaths prevented per year — appears to have been derived from a single paper that provided a particularly large estimate of the mortality effects of health insurance. Based on a wider range of studies, the actual number is likely to be smaller. - Long-term care: Sanders wants Medicare for All to cover the estimated $4 trillion cost of long-term care, which isn’t included in the Lancet study. The bottom line: Sanders’ claim that Medicare for All would be more efficient and thus offer some cost savings seems reasonable, but the idea that a more generous health care plan that covers the whole population, built atop the current immensely expensive medical system, would be cheaper to operate seems less so. The Lancet study Sanders has cited uses questionable assumptions that tend to overestimate the savings while downplaying likely sources of increased costs. As Vox’s Dylan Scott put it in [his review]( of the Lancet paper, “There is a lot of guesswork in projecting what Medicare-for-all would cost and the effect it would have — and this is just one more set of assumptions and estimates to add to the pile.” More harshly, the fact-check of the study from Kaiser Health News and PolitiFact says that while the study does cite evidence to back up its claims, “many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. ... [Sanders’] statement has some truth but ignores context that would create a dramatically different impression. We rate it Mostly False.” What do you want to read about? Send your feedback to yrosenberg@thefiscaltimes.com. Follow us on Twitter: [@yuvalrosenberg]( [@mdrainey]( and [@TheFiscalTimes](. And please tell your friends they can [sign up here]( for their own copy of this newsletter. 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