During President Biden's State of the Union address, he highlighted some of the most urgent, but often neglected, issues for which there have been bipartisan support: cancer research and treatment, veterans' care, mental health, and the opioid crisis.
Before the pandemic, a combined crisis of mental health, opioid addiction, and alcohol abuse had caused America's life expectancy to stagnate after decades of progress.
The risk is that, in the end, these issues end up being little more than applause fodder for the State of the Union speech, and more ambitious ideas about how to solve some of the most urgent problems in America today are never developed and never get off the ground.
Some of the ideas contemplated in Biden's speech have been around for years. Others amount to basic governance, laudable but hardly a moonshot: the dispersion of grants for school-based mental health, for example. Even in cancer, where Biden has consciously borrowed the language of the space race as a slogan for his efforts, one of the specific items for action named by the White House would be the reauthorization of two existing laws — worthy efforts but not exactly Kennedy-esque.
That the same issues continue to plague the health and well-being of Americans, and have for years, is an indictment of our ability to think big about how to fix them.
Why the issues on Biden's bipartisan agenda are so important
When I saw Biden's unity agenda, as well as his call for a $35 monthly cap on all insulin prescriptions for every American, what tied them together was an attempt to address the various drivers — chronic disease, suicide, overdoses, and other health consequences of substance abuse — of the country's dropping life expectancy.
US life expectancy, like that of other developed countries, had been steadily rising for the past half-century, reaching nearly 79 years in 2014. Then that growth started to level off and we saw some of the first drops in life expectancy in a lifetime. During the pandemic, the country saw a dramatic drop in life expectancy, hitting 76.1 years in 2021 — the lowest it has been since the mid-90s.
The influences driving that stagnation and decline (aside from Covid-19 itself) are complex and sometimes not mutually exclusive. But cancer is the second leading cause of death in the country and it seems to be occurring in more and more young people. Cardiovascular disease, to which diabetes is closely linked, is the leading cause. Overdoses and suicides are two prevalent causes of early deaths, and both have been steadily climbing in recent years.
Biden is speaking to the issues that are materially affecting people's physical and mental health right now. And Americans want action on these issues: 90 percent said in a recent survey that the US is in a mental health crisis.
These have also been issues where Democrats and Republicans have managed to make some small progress in recent years, such as the opioids bill that passed during the Trump administration. Members of both parties have also been advocates for increased funding to the National Institutes of Health and other medical research. Veterans are always popular with both parties, and have also seen bipartisan legislation passed to improve their care.
Biden urged Congress to support some new measures in the same spirit. It's good for a round of applause during a primetime speech. It's possible Congress could actually act on that call, though the odds are probably against it with issues like the debt ceiling looming.
But sooner or later, more drastic action may be necessary
We may need grander designs for mental health, opioids, and more. One word stuck out in the White House's proposals: parity. It was among the president's mental health proposals, a promise to make sure that health insurance plans cover mental health services with the same level of benefits they provide for physical health care.
That remains a work in progress in the US, and it sounds from the White House's description that new federal regulations will be coming. But it is hardly a new idea: The initial Mental Health Parity Act passed in 1996. Rather than a new policy to meet a moment of crisis, it was a recognition that prior efforts have failed to fully realize their goals.
Even on the cancer moonshot, a campaign dear to Biden's heart, some of the policy proposals kept the same limited focus. The White House is urging the reauthorization of two existing laws — the National Cancer Act, a bill that first passed before Biden became a senator, and the 21st Century Cures Act — to pass some new provisions that would help to support the NIH's work and hopefully make it easier for the drug industry and the FDA to bring new drugs to market.
There was one notable exception to that restrained approach: Much of Biden's agenda around mental health focused on limiting the potential of social media and online ads to harm the mental well-being of young people. He appeared to call for bipartisan legislation that would ban advertising targeted to minors. It would be an escalation of Washington, DC's war on the tech industry, which has also been one of the rare issues where members of both parties have expressed a lot of the same concerns.
But that felt like one of the few surprising ideas. Perhaps one should not expect surprise. Biden is by nature a measured policymaker, a consensus builder, and he is dealing with a divided government while arguing lawmakers should be able to come together to solve big problems.
But when one remembers that President Barack Obama, when Joe Biden was vice president, was singling out opioid abuse and touting progress on veterans' health care in his State of the Union speeches, it is a reminder of how much the US has struggled to think expansively about how to bring those problems under control.
