The long-awaited plan of Joe Biden to solve our Covid-19 pandemic is finally over. In his acceptance speech for the Democratic presidential nomination he revealed his plan – it’s what Trump is already doing!

Despite months of criticism of Trump’s handling of the virus by Biden and every other Democratic leader, they couldn’t come up with anything better. The Wall Street Journal editorial board says, “The Democratic nominee is also promising a better virus strategy, which would be wonderful if he had one. But the virus plan he’s pushing is little different on the substance than what the Trump Administration is already doing.” 

Let’s look at each step in the Biden Covid-19 plan:

• Virus Testing– Biden promises to “develop and deploy rapid tests with results available immediately.” The Food and Drug Administration (FDA) in the past week has approved two new rapid tests that can be scaled up quickly. After an initial delay in testing caused by errors at the Centers for Disease Control and Prevention (CDC) and FDA, supply-chain delays have been worked out. The U.S. is now conducting 700,000 tests or more per day, up from 400,000 in early June and 100,000 in late March. The cheap saliva tests developed by Yale researchers will avoid chemical reagent shortages and can cost as little as $10.

 

• More PPE, Test kits, and Lab supplies – Biden is calling for “a coordinated, country-wide, future-facing national effort to acquire, produce, and distribute PPE, test kits, and machines, lab supplies, and other critical supplies, including by fully utilizing the authorities” under the Defense Production Act. The Trump Administration is already doing all of this. In the hospital and surgery center where I work, there has never been a shortage of these supplies.

 

The Trump administration has effectively used public-private partnerships to rally the “arsenal of democracy” (the private sector) to produce the needed supplies for this pandemic. The Pentagon this spring issued $259 million in contracts to 3M, Honeywell, and Owens & Minor to produce tens of millions of N95 face masks for medical workers. U.S. companies like GM and New Balance have retrofitted plants to produce ventilators and PPE, and the Administration has used the Defense Production Act to allocate more tests and protective equipment to hot spots.

 

• Hire Federal Contact Workers – Biden has called for hiring 100,000 federal workers to track down contacts of people who get sick. States are already doing this, though public health officials say contact tracing is of little use when the virus is widespread in communities.California tried this approach this summer, training 10,000 contact tracers. But the Sacramento Bee last month reported most never were assigned work for inexplicable reasons.

 

• Increase vaccine production – Biden promises to “ramp up the large-scale manufacturing of as many vaccine candidates as necessary.” I guess he hasn’t been listening to the news from his Delaware basement. The Trump Administration and private industry are already on that. (see Vaccine Progress Due to Planning)

 

Health and Human Services this spring issued a $628 million contract to Emergent BioSolutions, a private firm, to coordinate with vaccine developers ramping up manufacturing capacity. The Administration has contracted with Johnson & Johnson, Pfizer, BioNTech, Moderna, and AstraZeneca for hundreds of millions of dosages as soon as their vaccines are proven safe and effective in trials. Pfizer and BioNTeach recently announced their vaccine is on track to seek regulatory approval as early as October.

The National Institutes of Health (NIH) is also funding promising treatments. Last month the Trump Administration signed a contract with Regeneron to manufacture 300,000 doses of its antibody cocktail by the end of the summer. On the other hand, Biden has proposed price controls and threats of prosecution of health-care executives. These measures would surely dampen the incentive to develop therapies and vaccines as soon as possible.

 

• Money for Schools to Reopen – Biden says he’ll give schools “the resources they need to be open, safe, and effective.” President Trump has said the same thing – if they reopen. Biden’s support for teachers unions threatens the ability of schools to reopen regardless of the federal financial support.

 

• National Mask Mandate – Biden also says he’ll impose a national mask mandate. Trump has encouraged masks in public, but left the decision up to the state governors. The Constitution doesn’t give the federal government the authority to mandate masks on a national level. That authority is left to the states.

 

 

There you have it, the Biden plan revealed. If you were looking for something exciting and different, you will be very disappointed. The Trump Administration is already way ahead of Biden and has implemented everything in his plan – except a national mask mandate. I guess Uncle Joe isn’t familiar with the Constitution.

 

 

Instead of taking an August recess, Congress could be taking steps to improve our healthcare. While it’s unlikely Congress can agree on anything, there are steps they could take before the election that would make a difference.

Brian Blase, writing in Forbes, says Congress should do the following to improve our healthcare:

• Codify the Trump price transparency rules
• Prohibit balance billing
• Expand Health Savings Accounts (HSAs)
• Provide states with greater Medicaid flexibility

 

Codify Price Transparency Rules

It’s really a no-brainer that patients should know the cost of what they are purchasing – before they receive their care. Polls show nearly 9 of 10 Americans agree. When patients know the cost of healthcare they become better shoppers, they lower the cost of their healthcare, and they force providers to compete not only on quality but also on price. This is good for patients and the overall cost and quality of the healthcare system.

The Trump administration has finalized a rule requiring hospitals to provide upfront prices for healthcare services. They are also requiring insurers to publish the amounts they reimburse providers for covered treatment. Blasé says, “Congress should lock in the Trump administration’s price transparency rules to end the legal battles over them and to give the American people the information they need to make smarter decisions about their health care and coverage.”

As a practicing orthopedic surgeon, I’m all for this price transparency. I want patients to know the actual cost of their treatment and I’m not afraid to discuss this in advance. But hospitals have traditionally balked at such proposals because they routinely vary their charges according to insurers and pre-determined contractual agreements.

Prohibit Balance Billing

Balance billing means billing patients more than the network cost-sharing amounts stipulated in their insurance contracts. The problem usually occurs when a patient goes to a hospital in their insurance network, but some of the providers working there are not in the network. The patient then gets billed more than their network coverage allows.

Congress should ban such balance billing so patients don’t receive surprise bills after they receive treatment at in-network hospitals or medical facilities. Providers who do not participate in the network should advise patients beforehand or accept the in-network reimbursement.

Expand HSAs

HSAs give patients more control over the spending of their healthcare dollars. These tax-deferred accounts incentivize patients to use these dollars wisely so they get the best value for their money. They have been shown to lower healthcare costs as much as 30 percent.

Currently, only people with a certain type of coverage – a plan with a high deductible that meets several requirements – can make HSA contributions. Congress should allow everyone, regardless of their insurance, to have an HSA. They should be able to continue contributions to these accounts even when they become eligible for Medicare, which currently disqualifies them. Recent legislation has been introduced by Texas Senator Ted Cruz and N.C. Rep. Ted Budd to allow anyone to contribute to an HSA during the extent of the coronavirus health emergency. This would be a useful first step.

Blase also believes Congress should consider contributing funds into HSAs for people with employer coverage who lost that coverage over the past few months due to the pandemic. He suggests Congress contribute $1500 to the HSAs of people with single coverage and $4000 to those with family coverage.

Provide States Greater Medicaid Flexibility

The Families First Coronavirus Response Act (FFCRA), signed into law this past March, provided a 6.2 percentage point increase in the federal reimbursement of state Medicaid expenses for traditional enrollment categories. This new law disproportionately benefits those states that expanded Medicaid under the ACA (ObamaCare). There is widespread evidence of fraudulent enrollment, especially in those states that expanded Medicaid.

The FFCRA actually prohibits states from taking steps to ensure only eligible enrollees are receiving benefits. This forces states to cover the costs of many ineligible enrollees, putting severe pressure on state budgets. Congress should undo the restrictions of FFCRA that prevent states from ensuring their Medicaid enrollees are actually eligible for benefits.

Two Steps Congress Should Avoid

These four steps Congress should take to improve healthcare. But there are two other steps they should avoid lest they contribute to worsening of our economic recovery from the pandemic.

In May, the House of Representatives passed legislation that fully subsidizes unemployed workers’ continued participation in their employers’ health plan through COBRA and expands ACA subsidies. The real beneficiaries of these funds are the health insurance companies. Blasé says the insurance companies are sitting on record profits because of the sharp drop in healthcare utilization by millions avoiding medical care due to the pandemic.

He says these subsidies also disincentivize workers to return to work leading to higher unemployment rates. Also, COBRA subsidies, in contrast to HSA expansion, locks recipients into using government aid only for COBRA premiums, which means they can’t be used in ways that would help these people more.

Avoid State Bailouts

Lastly, Congress should avoid bailing out states who have wasted taxpayers’ funds through poor governance. States that expanded Medicaid eligibility are a good example. If Congress feels compelled to provide aid to states and local governments, it should not be by raising the percentage that the federal government reimburses state Medicaid spending. Doing so would reward those states most wasteful and encourage states to further divert Medicaid money for other purposes.

Blase says potential reforms include: gradually lowering the ACA’s Medicaid expansion reimbursement rate until it reaches parity with the rate for traditional Medicaid recipients; requiring that Medicaid funds go for healthcare for the poor; permitting states to review Medicaid eligibility more frequently than yearly; requiring CMS to conduct annual eligibility audits of state Medicaid rolls and to make recoveries of improper state receipt of funds; and eliminating hospital presumptive eligibility.

All of the above makes good sense, but unfortunately our Congress is so divided that even common sense stands little chance of being considered. November will determine if we move forward with needed reforms to the current system or drive over the proverbial cliff and accept socialized medicine. Reform is better than suicide.

 

 

The whole world is waiting for a vaccine for Covid-19. Normally the development of a vaccine for a new virus takes years and billions of dollars of research. But fortunately, the Trump administration’s planning ahead of the pandemic is producing the fastest development of a new vaccine the world has ever seen.

The Democratic narrative claims the Trump administration was caught unprepared for a pandemic. During the recent Democratic virtual convention, New York Governor Andrew Cuomo had the audacity to claim “Our current federal government is dysfunctional and incompetent. It couldn’t fight off the virus. In fact, it didn’t even see it coming.” This is rich coming from the governor with the worst state record for corona virus treatment and the highest number of deaths, especially in nursing homes.

The truth is just the opposite. Joel M. Zinberg, clinical professor of surgery at Mt. Sinai Icahn School of Medicine, and Tomas J. Philipson, professor of public policy at the University of Chicago, tell a different story. In a Wall Street Journal Op-ed, they say preparation for a possible pandemic began long before the novel coronavirus emerged. In September, 2019, they developed a White House report called “Managing the Impact of Pandemic Influenza Through Vaccine Innovation.”

This report prompted immediate presidential action that accelerated the development of a Covid-19 vaccine. The report was produced by the Council of Economic Advisers at the behest of the National Security Council’s biodefense team. It detailed the large health and economic losses that could happen from flu pandemic in the U.S. The report discussed how the lack of private market incentives had led to underinvestment in developing and using innovative technologies that can quickly produce vaccines for a new virus.

Typical influenza vaccines have been manufactured in chicken eggs for the past 70 years. Recognizing the process is too slow to produce a new vaccine for a novel virus, a faster way was needed. Public-private partnerships created under a 2006 statute led to the development of newer, faster manufacturing techniques. But these vaccines are more expensive and haven’t been widely adopted.

The report recognized the need for rewarding innovation. To overcome the problem of under-investment in rapidly produced vaccines, it proposed public investment in public-private research and development partnerships to promote vaccine innovation and preferential government purchase of vaccines produced domestically from those partnerships.

On September 19, President Trump signed Executive Order 13887, which created several initiatives to modernize flu-vaccine production, including evaluation of “incentives for the development and production of vaccines by private manufacturers and public-private partnerships. When the novel coronavirus appeared a few months later, they were ready.

On March 30, less than three weeks after the World Health Organization declared a pandemic, the federal government began investing with private vaccine developers. The Trump administration launched Operation Warp Speed, which provided hundreds of millions of dollars to Johnson & Johnson, Moderna, and a partnership between Astra-Zeneca and the University of Oxford, England, to develop vaccines and provide 100 million doses by January, 2021 of each one approved, which the government will distribute free of charge. Similar arrangements were made later with Novarex, Pfizer and BioNTech, and Sanofi/SmithKline.

The results of this public-private partnership are amazing. Instead of years and billions to develop a new vaccine, we are witnessing months and millions to accomplish the same goal. Multiple advanced clinical trials are already in progress and two companies, Moderna and AstraZeneca have already begun Phase 3 trials. (Covid Vaccine Progress Encouraging).

Zinberg and Philipson also say the government is funding drugs to treat Covid-19, including $618 million to Regeneron Pharmaceuticals to develop an antibody drug and supply 70,000 to 300,000 doses. Late-stage studies of Regeneron’s drug to treat infected patients and protect uninfected people are under way, and it could be available by late summer.

In this time of hyper-partisan politics, Democrats are accusing the Trump administration of being caught unprepared for a pandemic. Fortunately, that narrative is false. Without the preparation of the Council of Economic Advisors (CEA) before this pandemic, we would not be looking at a new vaccine for years to come. The importance of this preparation cannot be overestimated.

The authors summarize: “The cost of Covid-19 from reduced economic activity and lives lost is estimated at $15 billion per day. Even though the pandemic came quicker than anyone imagined, the country and the administration were prepared to apply the CEA report’s lessons. New vaccines are being developed at previously unimaginable speed.”