Who Is Really Leading Healthcare?
By
Leonard Zwelling
In her column in The Wall Street Journal on January 11. Peggy Noonan discussed the two big speeches on the American horizon. The first will be President Biden’s farewell address. The second will be Donald Trump’s second inaugural address. The name of her column is ”Can Trump Bring Hope, and Biden Wisdom?” She goes on to discuss the darkness of the first Trump inaugural, but puts a closer lens on a past farewell speech. That was the one given on January 17, 1961 by out-going President Dwight Eisenhower.
Eisenhower, along with FDR, it can be safely said, was one of the most consequential American leaders of the first half of the 20th-century. His speech was about ten minutes long. In it he gave three warnings:
- Steady progress was more important to America than some “spectacular and costly action.” He warned against emotionalism in our politics. Talk about being ahead of your time. Isn’t that America’s current problem in spades. Everyone is angry about something.
- Eisenhower warned about the growing symbiosis between the military and our industry that arose during the Second World War—“the military-industrial complex.”
- His “third warning had to do with what he recognized as America’s technological advantage.” He feared that the nation’s intellectual progress would become dependent on government money. He also worried that “public policy could itself become the captive of a scientific-technological elite.” And hasn’t this all happened. It has if your progress in your academic career depends upon your acquisition of grant money and elite federal scientists can uniquely control our national response to Covid and do it pretty badly. And now we have Trump’s oligarchs controlling information.
Eisenhower’s predictions have surely come to be in modern healthcare. The push is always for the next big thing whether in weight loss drugs, vaccines, or cancer cures. There is definitely a healthcare-industrial complex dominated by big pharma and the drive in academia to spin off companies and make money when the original goal of academia was to unearth truth and discover new treatments. And, as we all know, academia is wholly dependent on federal grants and uses the funding system to determine success or failure in the climb toward tenure.
There is a real chance that all of this may change under Donald Trump. The NIH may well refocus on public health and drop some disease-specific funding. The intramural program in Bethesda, long in need of some revision if not elimination, may come under scrutiny. Seventy years ago a research hospital next to a research center may have been unique. There are hundreds across the country now. Is Building 10 still needed? What has really come out of the intramural program of the National Cancer Institute that constitutes a clinical breakthrough of late?
Finally, I have been having a running debate with a reader about the necessity of the CDC. The reader believes that the CDC is corrupt, in the pockets of the vaccine makers, and really not serving the American people. I believe that’s a little harsh, but the reader makes good points in that the first Trump Administration had no plan to deal with a pandemic and the CDC was shooting from the hip with no data most of the time. The CDC gets an F for Covid responsiveness. What’s worse is that even after Covid, there still isn’t a plan to respond to the next pandemic.
My argument is that we need some center for public health in the country that plans for preparedness of all kinds from threats to the public and has plans in place BEFORE the disaster occurs.
I have no expectation that the Biden speech will be revealing. I fear his mental condition sufficiently impaired that the words, if they come out, will not be his anyway. In retrospect, after I wrote this originally, I have no idea what Biden said except that he mimicked Eisenhower.
As for the inaugural address, Noonan is right. It needs to focus on hope. Listing the problems is not enough. We need solutions. They may, as Eisenhower counseled, be incremental, but they must be perceived. Let’s see if Trump can do that. Also, in retrospect, I listened to this whole speech and thought it pretty good, but Trump cannot govern by blaming Obama and Biden for everything any more.
Thus far, the healthcare focus has been on the hearings for RFK, Jr. I have found them worrying. I do not think RFK is the right choice for this job. Let’s see what the senators think.
It has been 17 years since Congress last addressed healthcare in the United States. What we got from that is ObamaCare. Not a failure, but not adequate. Many are still not insured. Costs keep rising and as the hearings for RFK made clear, quality is a thing of the past.
Whoever head HHS must rapidly identify the problems that are unique to the American healthcare system and begin to address them. It’s been long enough. We need something new—again.
