By DAVID INTROCASO<\/p>\n
After having worked in DC for sixteen years, in 2013 I created\u00a0The Healthcare Policy Podcast<\/a>.\u00a0 The title was in part intended to be sarcastic because healthcare policymaking in DC is very narrowly drawn.\u00a0 Consequently, healthcare delivery is excessively commodified, reductionistic and financialized or in sum anachronistic and ironically lacking purchase.\u00a0 If the policy objective was health, we\u2019d be healthier.\u00a0 We\u2019re not.\u00a0 For example, though anthropogenic warming poses\u00a0the<\/em>\u00a0greatest threat to human health, we\u2019ve no related healthcare policy.\u00a0<\/p>\n Among more conventional issues, there is no serious policy discussion regarding HHS\u2019s mission \u201cto enhance . . . the well-being of all Americans.\u00a0 That we treat the disease not the person means we define health as simply the absence thereof.\u00a0 The same for excess deaths, comparatively declining life expectancy and compressing morbidity among Medicare beneficiaries who will soon exceed 20% of the population.\u00a0 As for children, HHS\u2019s recent \u201cMake Our Children Healthy Again<\/a>\u201d report expressed concern about children\u2019s aerobic fitness but was silent about the prevalence of childhood sexual abuse despite Jeffrey Epstein and the Congress\u2019s own serial child molester\u00a0former House Speaker Dennis Hastert.<\/a>\u00a0\u00a0Bizarrely, the AMA has yet to rescind Speaker Hastert\u2019s\u00a02006 Nathan Davis award<\/a>\u00a0for \u201coutstanding contributions to the betterment of public health.\u201d\u00a0 The HHS report was also silent about Medicaid reform even though the program provides healthcare for roughly half of US children. \u00a0It is similarly remarkable how seldom if ever names like Arrow, Canguilhem, Farmer, Foucault, Illich, Marmot, Starfield and Virchow are discussed in healthcare policy circles. \u00a0<\/p>\n Now after OBBBA cuts to the Medicaid and Medicare programs, 500 rounds fired into six CDC buildings, one killing a police officer, and seven months of HHS moral obliquity we are confronted with the reality that healthcare policymaking is now unambiguously on the road to nowhere.\u00a0 This may be because, having failed to appreciate Richard Hofstadter, Humphrey Building leadership is busy fomenting a new chapter in anti-intellectualism.\u00a0 We\u2019re left to ask if healthcare enshittification has now been achieved possibly because healthcare policymakers have adopted Mark Manson\u2019s \u201cThe Subtle Art of Not Giving a F*ck.\u201d<\/p>\n The good news is the storm and stress about HHS no longer being fit for purpose could be effectively cured if the Congress, along with support from MedPAC, MACPAC and others, would work to free the department from politicization or partisan influence by redefining it as an independent agency.\u00a0 If policymakers exercised more imagination such a simple and obvious reform would have already received serious attention.\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n The idea of an independent HHS has at least been recognized.\u00a0 Roughly twenty years ago Dr. Arnold Relman, the esteemed former editor of\u00a0The New England Journal of Medicine, argued healthcare be managed by a \u201cNational Health Care Agency<\/a>\u201d defined as a hybrid public-private entity like, he said, the Federal Reserve.\u00a0 Similarly, HHS would be governed by an independent board whose members would be nominated by the president and confirmed by the Senate for 14-year terms.\u00a0<\/p>\n <\/span><\/p>\n The idea surfaced again in some detail in 2016 when six former FDA commissioners, four appointed by Republican presidents, recommended the\u00a0FDA become an independent agency<\/a>.\u00a0 The commissioners argued the FDA\u2019s independence was necessary to firmly ground decision making in scientific evidence, speed innovation, promote the capacity to act swiftly and to enhance accountability, transparency and public confidence.<\/p>\n Six years after that the Government Accountability Office (GAO) stumbled onto the idea.\u00a0 Early in 2022 the GAO added HHS leadership to its Congressional \u201cHigh Risk List<\/a>\u201d that identifies executive department operations and programs facing serious mismanagement and in need of transformation.\u00a0 HHS leadership was named because the GAO learned from the CDC, FDA, NIH and the Administration for Strategic Preparedness and Response (ASPR) that political interference may have compromised HHS\u2019s COVID-19 response.\u00a0<\/p>\n