Ending the HIV epidemic in the United States will take effort far beyond implementing policies about HIV. A president who wants to end the epidemic must consider health care policy, reproductive justice, mass incarceration, housing, immigration and myriad other issues that drive the epidemic’s numbers in marginalized populations across the U.S. As the 2020 Democratic primary begins its early voting, TheBody asked prominent writers and activists to consider how each Democratic candidate, if elected, would fare in ending a health crisis that is now in its fourth decade.
The presidential campaign of John Delaney may only be remembered for the moment during the July Democratic debate when Sen. Elizabeth Warren, responding to his criticism of her health care policy agenda, said of him, “You know, I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for. I don’t get it.”
The live audience in Detroit howled. Twitter gasped. The media put it on loop.
For those who watched the evening’s debate from its beginning, Sen. Warren’s comments seemed a reasonable dig at a candidate who had used his opening remarks to proclaim, “Folks, we have a choice. We can go down the road that Sen. Sanders and Sen. Warren want to take us, which is with bad policies like Medicare for All, free everything, and impossible promises that will turn off independent voters and get Trump re-elected.” But was Warren’s criticism fair? Does Delaney’s relative stance on health care mean he won’t fight for it? Does it mean he cares little for the health of Americans? What about the health of those living with HIV? Or those most at risk for contracting the virus?
Will John Delaney, if elected president, fight to end the HIV epidemic?
To begin to answer that question, one needs to first know the man himself, understand the district he represented from 2013 to 2019, and consider how each have informed his short political career and now his presidential platform.
Delaney grew up in a working-class household, before going to college and pursuing a career as an entrepreneur. After building two companies and taking them public, he became a multimillionaire. The first company was Healthcare Financial Partners, a business offering health care receivables financing, or lending money to medical services providers against the anticipated payment of medical bills. According to current estimates, Delaney’s net worth exceeds $200 million.
Maryland’s sixth congressional district, which Delaney served for six years, lies within the westernmost part of the state, where the Mason-Dixon Line and the Potomac River intersect in the foothills of the Blue Ridge Mountains, the Great Valley, and the Appalachians. It’s predominantly rural, with a few small, historic cities that grew in the 19th century along the National Pike and the B&O railway.
Traditionally, the sixth district was both economically and demographically more homogenous than the parts of Central Maryland lying within the I-95 corridor. Prior to re-districting, the incumbent Republican had represented the area for 20 years and was a cofounder of the Congressional Tea Party Caucus. Were it not for the gerrymandering of the General Assembly in order to include heavily Democratic suburbs and exurbs of Washington, D.C. in the district, the seat would still be held by a Republican today.
But even the deeply Democratic parts of Maryland’s sixth are defined by the sort of respectability politics that pairs fervent outrage over fracking in the state (however remote) with opposition to affordable housing in one’s own neighborhood (however limited). The residents of Montgomery County, whose precincts provide the votes needed to keep the sixth district from returning to Republicans, keep faith with a genteel notion of wealth that believes government should help the poor to the extent that it doesn’t cost too much, doesn’t encroach too far into the best school districts, and doesn’t negatively affect one’s property value.
By his own admission, Delaney shares these values. Launching his campaign in 2017, he wrote for The Washington Post, “As a progressive businessman, I’ve made it a priority to be solutions-oriented and have been consistently recognized as one of the most innovative and bipartisan members of Congress. I’ve done this by simultaneously celebrating the power of our free-market economy while insisting that there is a role for government to set goals and rules of the road and take care of those who are left behind.”
His performance in the July debate was intended to position him as a centrist, pragmatic alternative to the Sanders-Warren version of “too-far-left progressivism.” Measured against those candidates, he’s undeniably a moderate. But his public platform is more substantive than “can’t do” and “shouldn’t fight for.”
On health care, Delaney is undeniably running against “Medicare for All” as proposed by Sanders and Warren, but he’s nonetheless offered a plan called “BetterCare,“ which is based on the fundamental assumption that health care is a basic right. In an interview with CNBC, a leading business news outlet, he said of his position, “I think we should have universal health care. Every American should have health care as a right. I think it’s a human right.”
However, BetterCare explicitly maintains a system of private insurance and includes tax credits for those who choose to purchase it. Additionally, the system would encourage employers to negotiate group rate supplemental plans that would “merge with the basic governmental plan.”
Yet, despite the centrality of universal access to health care in any efforts to end the epidemic, there’s absolutely no mention of HIV in Delaney’s discussion of BetterCare.
In fact, there’s a complete lack of any discussion of HIV in the parts of Delaney’s platform where one would most likely find it—not just in health care, but everywhere. In fact, the most defining characteristic of the Delaney campaign’s position on HIV is its total absence of any position on HIV.
Some clues for guessing at Delaney’s willingness to confront the HIV epidemic lie in the public health crisis around which he has outlined an explicit platform. In his plan for addressing the opioid crisis, Delaney covers many of the aspects included in strategies for ending the HIV epidemic—access to care for patients, destigmatizing the act of seeking care, and measures for holding accountable the pharmaceutical industry.
Here too, though, is an equally notable silence about a key point of intersection between the HIV and opioid crises—namely, in transmissions from non-sterile injections. Nowhere in his discussion of the opioid epidemic does Delaney offer support for harm reduction methods such as programs for deploying safe injection sites and needle exchanges. Nor does he indicate a need for increased HIV testing in substance-abuse treatment facilities, which might alert individuals of their status in order to connect them with HIV-related care.
Similarly, the Delaney platform related to the LGBTQ community makes no mention of HIV. While he promises to ban conversion therapy and to support the Student Non-Discrimination Act, there’s no discussion of queer-positive sex education in schools even as almost a quarter of new transmissions reported in 2017 were among gay and bisexual men under the age of 24. And while the platform makes it clear that Delaney supports the right of trans men and women to serve in the armed forces, it fails to address the disproportionate impact of HIV on members of the trans community or the discriminatory military policies towards servicemembers living with the virus.
It’s disappointing that any candidate to be the Democratic nominee for president would have so little evidence to consider on the topic of how they would combat the HIV epidemic. But for Delaney, it’s not entirely surprising.
What most characterizes the Delaney candidacy on issues related to HIV is how much it conforms to the political attitudes of Maryland’s sixth district. In March 2019, the Kaiser Family Foundation released a poll which found that only 12% of white adults were very concerned or somewhat concerned about getting HIV, and they registered the lowest rates of concern about HIV as a serious issue. The communities where HIV continues to generate the most concern, according to the poll, are communities of color. In Maryland, the places most directly impacted by the epidemic are Baltimore and Prince George’s County.
Ending the ongoing HIV epidemic will be a challenge for any president, because the policies required to do so are the ones that will push the bounds of the market-oriented respectability politics that are at the core of Delaney’s entire platform. His approach to policy is defined by the direct and indirect influence of the system of financing health care that made him incredibly wealthy.
John Delaney, if elected, isn’t prepared to deliver an end to the epidemic. What’s needed to achieve it—at a minimum—is a system of health care that has constrained the profiteering motivations of multiple “free-market participants,” including insurers and pharmaceutical manufacturers. Beyond that, eliminating new transmissions will require public policies targeted at issues most people are uncomfortable discussing—teaching queer-positive sex education in the nation’s public schools, making no-cost pre-exposure prophylaxis (PrEP) available to teenagers and those engaged in sex work, making sure clean needles are available to those who will inject themselves whether or not the general public condones it, and much more.
It’s possible a Delaney administration might develop a strong commitment and well-defined plan to ending the epidemic if motivated by activists, public health experts, and other elected officials. But HIV has been a public health crisis for more than a generation, and anyone who’s served in Congress—especially one who arrived with decades of experience in the health care industry—should already have defined policy positions for addressing HIV. Delaney had six years in the U.S. House of Representatives to do so, but the 18 HIV/AIDS bills joined are barely 2% of the total legislation he sponsored or co-sponsored.
When it comes to HIV, silence and inaction are all that Delaney has offered voters as a candidate for president. What information is available for making a basic inference does little to inspire hope that he would preside over the end of the epidemic. Perhaps Sen. Warren was right to rebuke him.