In Trump-voting rural USA patients are dying of Covid insisting it’s a hoax. In North Dakota, hospital staff shortages are so severe that the state’s interim health officer has changed the rules to allow healthcare workers with asymptomatic COVID-19 to continue working in COVID-19 hospital units and nursing homes.

Despite the denials of its existence, fuelled by an avalanche of Trump-driven viral fake news on social and mainstream right wing media, Covid has made its presence tangibly felt. By November 10,  hospitals were on the brink of being overwhelmed by Covid patients in Iowa, Kansas, Minnesota, Missouri, Montana, North Dakota, Texas, Utah, and Wisconsin, and officials in many other states were warning that their health-care systems would be dangerously stressed if cases continued to rise. By November 13 numbers of Covid patients admitted to US hospitals had increased 40% in two weeks – while the defeated president sulked idly in the White House. ICU beds were approaching 90 percent occupancy in multiple states, and some metro areas are now completely full and declining patient transfers.

It’s a tough time for a new President to be preparing to take over, and a fresh summary of Joe Biden’s health plan makes clear that all of the current problems of overpriced insurance policies and grasping hospital corporations would remain intact as obstacles to millions of poorer Americans accessing health care when they need it.

Even if Biden was able to implement his plan in full – now made most unlikely by the failure of the Democrats to wrest control of the Senate from the Republicans – it would offer little substantial change: most working people would continue to get their health insurance through their employer, Medicare and Medicaid would be preserved, and the battered remnants of Obama’s Affordable Care Act (ACA) would be dusted off and expanded.

Biden has argued for a “public option” minimal insurance plan to be offered to Americans on low incomes or working for smaller employers – including around 4 million people living on low incomes in the dozen states that have refused to comply with the ACA’s requirement to expand Medicaid as state support for the poorest.

The Kaiser Family Foundation estimates that up to 12 million people with employer coverage — less than 10 percent of the total employer-based market — might find the public option to be a cheaper alternative for them. Biden has also argued for increased government subsidies to enable people to afford  the premiums, and has proposed to offer the subsidies to some Americans with higher incomes, too. Up to 24 million people without insurance could get some form of coverage.

But all of this leaves a vicious and unpopular system of health insurance intact, buoyed up with government funds, and many people on poor value “bronze” insurance plans that leave them saddled with most routine health costs.

Meanwhile in a sign of the times the American Medical Association, historically a conservative body, has adopted a policy that recognizes racism as a public health threat and calls on the AMA to “support the creation of external policy to combat racism and its effects and encourage federal agencies and other organizations to expand research funding into the epidemiology of risks and damages related to racism.”

Sadly this commitment to attacking one of the main root causes of health inequalities has not been coupled with any change from the AMA’s historic opposition to “single payer” health insurance to bring all Americans into a single tax funded system of Medicare for All. November’s elections have brought some change – but too many aspects of health care remain just the same.

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