Taxpayers and lawmakers have ensured that the federal Health and Human Services agency operates with roughly $2 trillion in discretionary and mandatory funding. This means the agency can employ about 80,000 staffers, many of them top experts in medical science, health care policy, and public health.
This concentration of expertise and experience, however, may mean less than ever.
That’s because just one man, and his hand-picked few, insist that they hold the absolute power to make life and death decisions for more than 330 million Americans, especially when it comes to health care and government spending on it.
Will President overrule FDA on vaccine testing?
The federal Food and Drug Administration, joined by leaders in the global pharmaceutical industry, have not only pledged to protect the process that usually would assure the public of the safety, effectiveness, and availability of a vaccine against the novel coronavirus that causes Covid-19.
Medical experts also announced they would take steps to step up the rigor of the vaccine testing, even though that might mean information might not be available as swiftly as possible for widespread inoculations to get under way to try to end the global pandemic.
Yeah, no, declared President Trump. He said if he disagrees with what he called scientists’ ‘political moves’ — though he did not explain how or why he would do so — he insisted he will overrule them and may grant emergency approval for a prospective vaccine’s use. Just before the election.
The president, who has asserted without evidence that a coronavirus vaccine would be approved by Nov. 3, undercut his own experts, notably Dr. Stephen Hahn, head of the FDA.
Public heath experts, medical scientists, and other politicians pushed back at Trump’s declaration that he would short-circuit rigorous testing of a coronavirus vaccine, with some leaders at the state level saying they would seek their own review of any inoculation given emergency approval by the president alone. (African American doctors, citing the disproportionate harm done to communities of color by the coronavirus and historic abuses of minorities by the medical profession, have gotten together and announced plans to conduct their own, separate reviews of data on any prospective Covid-19 vaccine).
Trump’s vaccine remarks, to be sure, were just part of what has become near daily assertions by the president, without fact or evidence, about major health care issues, or media revelations about hard to explain White House involvement in federal health agencies.
Taxpayers to cover cost of cheery and costly ad campaign
The news site Politico, for example, kept following up the scandals involving two of Trump’s direct appointees in top communications roles at HHS. This story has focused on Michael Caputo (right), a political operative with zero health care experience but put in one of the sprawling health agency’s leadership roles, was forced to apologize, then took medical leave after publicly ranting about conspiracies in government and assailing those who had worked with him at HHS. Paul Alexander, an obscure Canadian health researcher given major responsibilities at HHS, left with Caputo.
Before Caputo left, though, he pushed through his plan to take hundreds of millions of dollars away from the disease-fighting Centers for Disease Control and Prevention, sinking them, instead, in a cheery and expensive advertising campaign. The ads will push hope and optimism about national efforts to combat Covid-19, effectively endorsing the administration’s shambolic pandemic response. It has left more than 200,000 Americans dead and more than 7 million of us infected.
But that harsh reality won’t be part of the planned HHS ad campaign, which the administration wants to star its favored personalities like Dr. Mehmet Oz, gospel singer CeCe Winans, country singer Garth Brooks, and actor Dennis Quaid. Instead, Caputo has said the upbeat messages will be about “defeating despair.”
Public health officials criticized the plan, noting that the administration has spent little on helping Americans understand evidence-based steps to battle the coronavirus, like hand washing, distancing, and face covering. With opposition rising to vaccines, experts asked why taxpayer dollars aren’t going toward a campaign to increase awareness about a nationwide push to vaccinate Americans against Covid-19?
Caputo, since his departure on a medical leave, also has said that he has been diagnosed and will be treated for cancer.
She goes from UM lacrosse to top health policy post
His leaving was not the end of the political shocks at HHS, where the White House also pulled from the agency its two powerful liaisons: Emily Newman and her deputy Catherine Granito (right), Politico reported. This was the hard-to-fathom revelation in this news story:
Newman’s departure actually had occurred months ago, and that “meant that Granito — an undergraduate at the University of Michigan as recently as this spring — had been in charge of the health department’s personnel while playing a role in shaping policies in the middle of a pandemic.” Granito’s public profile on the career site Linkedin shows that she was known as an undergraduate as a lacrosse player until she finished at UM earlier this year. She received an English degree, and her cited health care experience as an undergraduate was as a “weekly volunteer and student athlete coordinator for Mott Children’s Hospital visits.”
Politico’s story did not make clear if Newman and Granito, as White House liaisons with staffing sway, had a role in the personnel decision that put Emily Miller, another GOP political operative and briefly a broadcaster, in the role of chief spokeswoman for the FDA. Miller was ousted quickly in a debacle involving FDA chief Hahn and major misstatements of basic scientific fact about a medical study on convalescent blood plasma used to treat coronavirus infections.
(The HHS personnel imbroglios, by the way, may not have rated as the strangest. Instead, that notoriety may go to the National Institutes of Health. There, a little-known staffer in the agency’s internal communications operations retired suddenly after an online news organization reported he was, on an extremist web site, a harsh, anonymous critic of the coronavirus expertise of Dr. Anthony Fauci. Fauci, one of the NIH’s revered infectious disease experts, far outranked and would have been a boss of sorts of his critic.)
Do fact-free assertions make up a health care plan?
As for the president, he persisted in pushing his fact-free assertions about his administration’s health care record, notably with an event that may have been Trump finally laying out a health plan promised for roughly five years.
If this was Trumpcare, it may not have been what an incumbent would wish to trumpet. The president laid out a list of pronouncements and executive orders — none carrying weight of law or details on how they would be carried out to benefit Americans.
The president, for example, pronounced that his administration would protect patients from insurers denying them health insurance based on pre-existing conditions. This is a situation that could affect more than 50 million Americans, including those with employer-provided coverages. The number also is rising because patient advocates note that insurers, given the chance, would tag coronavirus infection and care as counting against people as a pre-existing condition.
Here’s the rub, though, with Trump’s executive order: Americans already have pre-existing condition protections under the Affordable Care Act. And Trump, joining Republicans in his administration, Congress, and state houses have fought to kill the ACA, including in a federal case scheduled for argument before the U.S. Supreme Court a week after the election. Trump and the GOP have been in full gallop to fill the seat vacated by Justice Ruth Bader Ginsburg’s death with Amy Coney Barrett (shown above), a conservative jurist who opposes the ACA.
If the court strikes down the ACA, not only would pre-existing condition protections vanish (remember that the Trump order does not explain how the safeguards would be preserved), so, too, would be: popular protections against insurers imposing annual and lifetime coverage limits, allowances so parents can keep children up to age 26 on their policies; and programs providing preventive and women’s health care.
A $6.6 billion surprise give-away to seniors
By the way, the president also pulled out of thin air one more whopper that would make a certain burger franchise blush: Trump announced that the federal government soon would send 33 million Medicare recipients each a $200 discount prescription drug card.
When will seniors get this money from the sky? Why? And who will pay for this $6.6 billion largesse?
Administration officials scrambled to answer those and many more questions, with much focus on how taxpayer money, by presidential fiat, would be pulled from an account — the Medicare Trust Fund — without explanation of how it would be replenished for its ample need.
Officials suggested that not only did the president have the authority for his giveaway (it’s a claimed “experiment” in approving medical care — that’s a small and approved use of some Medicare sums) but also that the money would be repaid. How? Hold your hat: Officials have argued that a drug pricing plan that the president has pushed, again, by executive order would result in sufficient savings to cover the billions diverted in his Medicare give-away. The problem detail: the “most favored nation” drug plan, which might hold U.S. makers to some favorable prices set in other nations where governments have cost-control powers, is far, far from being in place. So, the president is spending money on his own say, without knowing that it ever will be replaced.
The latest vapors surrounding senior drug cards echo a head-scratching report that Big Pharma and the White House had neared a cost-control deal on prescription drugs. It purportedly got scotched because Trump demanded the deal include $100 cards as a Medicare giveaway, and drug company execs balked at this because the president wanted the materials branded as virtual re-election endorsement ads.
Moving money around like its yours
Wait, this kind of skeevy sloshing around of taxpayer money and brute politicking, reminiscent of Chicago ward heelers walking around and giving poor folks a few bucks in exchange for their votes, doesn’t happen in 21st century America, right? Well …
- Florida may be on the most hotly contested states in the presidential election. It also saw a surge of voters displaced after hurricanes tore through nearby Puerto Rico. The president, who long has assailed leaders on the island over their recovery aid requests, suddenly announced that $13 billion in congressionally appropriated but administration withheld disaster aid will go to Puerto Rico.
- With his trade and tariff battles with China battering U.S. farmers, Trump before the pandemic had poured tens of billions of dollars in aid to agricultural interests (mostly Big Ag) in the Midwest. The money has amounted to twice what the government spent to rescue the auto industry, but with a key difference: This administration has never gotten congressional approval for the spending, and it is not only unclear how aid payments from a farm lending program might be returned to the government treasury. Further, farmers — again, Big Ag, mostly — have grown dependent on this flowing federal cash and experts don’t know what calamities might ensure when it ends, especially since Trump keeps throwing money out there.
- Congress, heeding pleas from military leaders, appropriated $1 billion to the Pentagon to ensure the nation’s armed forces would have needed medical supplies to respond to the coronavirus. But what was more important than, say, masks or personal protective equipment (PPE), or perhaps appropriate and added stocks of medical devices and prescription drugs? How about defense contractors. The Pentagon, according to the Washington Post, worried about the well-being of their suppliers, so officials swiftly shuffled the medical supplies money to pay vendors to provide “jet engine parts, body armor, and dress uniforms.” Military leaders argue that it is vital for the nation to protect its defense suppliers and supply chains. Congressional Democrats are outraged about the diverted money.
A billion here, a billion there? Federal health officials say they are short $6 billion needed to pay for a nationwide campaign to vaccinate Americans coast-to-coast against the coronavirus if makers develop a safe and effective vaccine. Congress, though, is deadlocked on further pandemic spending, and a bruising confirmation process may mean that lawmakers go into yet another recess without taking up Americans’ needs as the nation staggers through the fall and winter of its worst health crisis in a century.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent health care. This has become an ordeal due not only to the coronavirus, but to the skyrocketing cost, complexity, and uncertainty of therapies and prescription medications, too many of which turn out to be dangerous drugs.
The pandemic has exposed not only the frailties of the world’s most costly health care system (ours), it also has pounded home its inequities, inefficiencies, and ineptitudes. While we pay more than our peers in other rich, industrialized nations for our health care, we get poorer outcomes — and we bear the crushing weight now of the world’s worst situation with Covid-19 (deaths and infections). We have much work to do to see that we emerge from this health nightmare in a far better place. We all need to research carefully, think hard, and vote like our lives depend on what we do in the days ahead. They will.