As we get ever closer to the one year anniversary of President Trump’s unexpected (and refreshing) rise to power, several of his campaign promises have come into sharper relief than others. Some, the President obviously isn’t interested in compromising on, such as immigration enforcement, nominating conservative judges, or a general refusal to apologize for cultural conservatism and America’s “deplorables.” Others, the President has treated more like opening offers in an ongoing negotiation, such as his stances on trade with China, or war with Afghanistan. And still others, the President has shown every willingness to execute but has been blocked by the Swamp either through Congressional inaction or by stacking his White House with people unwilling to follow through.
Tax reform and infrastructure payment arguably belong in this last category, but the giant, killer example to top them all is the area of healthcare. In fact, arguably this is the area where Trump’s own touch is least evident, given his hands-off approach to Obamacare repeal, and given his decision to permit his Vice President to commandeer the HHS Department with allies.
This last decision has borne highly dubious fruit. As Stat News notes, President Trump has ended up in the paradoxical position of publicly denigrating the pharmaceutical industry (correctly), while simultaneously filling his White House with its allies or members. In fact, apparently, people as high up as Trump’s nominee for HHS Secretary to OMB director of health programs Joe Grogan to HHS’ Keagan Lenihan possess levels of closeness with the industry they’re charged with regulating that are virtually unprecedented for public servants.
This is not necessarily a bad thing. President Trump himself ran on just such a paradox: that he, a man who had bought off all the politicians and knew how to manipulate policy to his advantage with his giant bank account, would turn that understanding of the corrupt system to benefit the American people as a way of “giving back” to the country that had made him so rich. Given the byzantine and opaque nature of America’s healthcare system generally, and drug pricing in particular, it is far from unreasonable for someone to believe that people similarly situated to Trump are needed to pull the same trick. A skilled former pharma executive who, having made all the money he’d need, would turn his talents to public service is, in theory, a highly attractive choice to lead HHS or similar departments. Whether this is true of Alex Azar, President Trump’s nominee for HHS Secretary, very much remains to be seen.
However, there is an obvious danger to such an approach: you may end up snatching not devoted public servants, but mere toadies committed to using the power of government to improve their industry’s financial position, whatever the cost. There’s nothing wrong with keeping an eye toward profitability, of course: it often drives innovation and keeps the quality of products offered high. But to focus on it at the expense of all else is not what we hire public servants to do. Not to mention, profitability in the pharmaceutical sector is a highly imperfect signal of market efficiency, largely because America’s healthcare system is not a market: it’s a series of controlled monopolies, often propped up by corporate welfare.
That sort of system is begging for Trumpian disruption. But it is a fact that under the current crop of people acting in this White House, we have gotten anything but Trumpian disruption. Instead, we have seen programs relied upon by the very people who voted this President into office gutted to pad Pharma’s bottom line and a bewilderingly hands-off approach to the industry’s part in the opioid crisis.
The bottom line is that Trump needs a better way to gauge the intentions of his future staffers, and that starts with a recognition that not all successful businesspeople in a particular sector are inclined toward public service for its own sake, but sometimes, instead, for the sake of their old industry’s bottom line. At a minimum, Trump should be much more forceful in trying to probe for this instinct before appointing people. Ideally, he would recognize that in this case, perhaps the antidote to swamp groupthink is to refuse to hire the people who profited off the swamp to begin with.