When it comes to health care, our political system has been locked in a debate over Obamacare while far more modest — but crucial — reforms have gotten little attention. This policymaking failure has had real, dire consequences during the Covid-19 pandemic.
In fact, many regulations originally designed to expedite our country’s response to a health crisis have ended up delaying it. For example, the University of Washington and other research centers developed their own tests, but were delayed for weeks by arcane rules, such as a federal Food and Drug Administration requirement to send paperwork by snail mail.
Other outdated regulations proved similarly harmful. FDA regulations also initially prohibited academic labs from testing for the virus altogether. Others from the Centers for Medicare & Medicaid Services blocked most Medicare patients from using telehealth to see their doctors from the safety of their homes. Still other state-level restrictions limited the ability of doctors to treat patients across state lines and hospitals to add more beds.
To their credit, federal policymakers and governors of both parties relaxed many of the most harmful regulations, but only temporarily. Making them permanent — as well as eliminating others that have long outlived any supposed usefulness — will be a far more difficult task.
Ensuring America’s health care system is better able to respond to this pandemic — and to provide more access to affordable care in more normal times as well — requires a top-to-bottom reevaluation of the federal role in health care, with a focus on fixing regulations that act as barriers to better care.
But how can lawmakers enact reforms on such a polarizing issue — and during an election year? Our experience shows there is an effective model that could meet this challenge, one that already has the backing of groups as philosophically diverse as the Progressive Policy Institute and the free-market Mercatus Center at George Mason University — a national commission.
We served — one of us as chairman, the other as a legislative aide — on a national commission that modernized another of America’s most important, yet politically sensitive, assets: our network of domestic military bases.
When the Cold War ended, our country’s defense priorities changed from deterring a Soviet attack to confronting more modern security challenges, making many of America’s military bases obsolete. Closing them required overcoming two daunting obstacles.
First, parochial political interests tended to supersede the public interest. Members of Congress worried that if the local military base closed, it would result in economic damage their opponents would use against them. Reforms also faced “congressional inertia.” With 100 senators able to deploy procedural maneuvers and all 535 members of Congress able to trade off key details, bills would essentially get debated to death or watered down to the point of being meaningless.
Congress addressed these problems in 1988, when lawmakers from both parties agreed to impanel the Base Realignment and Closure Commission (BRAC). Made up of independent defense experts, it was charged with recommending to Congress a list of military bases no longer needed. Importantly, lawmakers were required to take an up-or-down vote on the entire package — no amendments, no gimmicks.
This proved a resounding success. Five BRACs were empaneled between 1988 and 2005, resulting in the closure of nearly 350 no-longer-needed installations. According to a 2017 Pentagon report, those closures now save $7 billion every year and, more important, they strengthen our national defense by focusing resources more efficiently.
Covid-19 represents a similar watershed moment for modernizing American health care. As with base closures, parochial political interests are a persistent barrier to health care reform. And once the immediacy of the current crisis begins to subside, congressional inertia will also set in. Even popular reforms can take years and multiple Congresses to enact. The 2018 legislation giving terminally ill patients the right to try potentially life-saving medical treatments, for example, took four years to pass — despite the fact that nearly 80 percent of Americans supported it.
A BRAC-style commission is uniquely capable of overcoming these challenges. It would be comprised not only of lawmakers, but also doctors, scientists, health care experts and innovators who have firsthand experience with the problems they are solving — and don’t have political skin in the game. Requiring an up-or-down vote on a final package of recommendations would shield commonsense reforms from needless delays.
Some say this sort of commission lacks accountability and public transparency. Not true. Lawmakers still vote on the rules for the commission. They still vote on final reforms. And the commission would be open for public comment — with all proceedings open to the public, too.
Others question whether regulatory reforms can meaningfully hold down costs and expand access to high-quality care — the top two concerns cited by Americans today, and the stated goal behind "Medicare for All,” a public insurance option, and other forms of government-run health care programs.
Multiple examples show the answer is yes.
Telehealth-based programs in the Veterans Health Administration have reduced hospitalizations by up to 40 percent and saved $6,500 for every enrollee. Beyond the VA, studies show digitally delivered care typically costs about half that provided in doctor’s offices and urgent care clinics. Others show it can dramatically reduce emergency room visits for patients with high-risk chronic conditions. Within just two months of Medicare approving more than 80 new telehealth services in response to the coronavirus, more than 11 million people had begun using them, while doctors’ offices report 50 to 175 times more tele-visits than before the pandemic.
Beyond telehealth, the regulatory waivers have sparked innovation that has saved lives. Drones are now delivering personal protective equipment and other medical equipment in North Carolina. Waivers from CMS have eased access to ventilators. These are just a couple of examples that show the revolutionary benefits of modernizing our health care.
To be sure, a BRAC-style commission will not fix every problem with Americans’ health care. But by removing a post-pandemic regulation review from the day-to-day political fray, it will better enable public servants to enact reforms that will save more lives now and in the future.