GOVERNMENT RUN LIKE A

BUSINESS? MORE LIKE BUSINESS

RUNNING THE GOVERNMENT

Michael B. Lax, MD, MPH March 31, 2017 Some say that Donald Trump doesn’t really have an ideology. He’s a businessman, meaning a pragmatic deal maker, skilled in the art of negotiation. With these character traits, he’ll be good at getting the job done, breaking through the grid lock created by politicians beholden to partisan ideologies. Trump supporters are also fond of the idea that government should be ‘run more like a business’. They seem to share the conception described above, of non partisan government committed to efficiency and results. But in addition there is an economic component: that like a business, government should be responsible with its money, balancing expenses and revenue, and accumulating no debt; that the government should only collect taxes to fund itself for limited and essential functions; and that those limited and essential functions do not include the redistribution of resources to address, even partially, inequalities. Trump has only been in office for about two months, but he has striven to put his immediate stamp on Washington, and has already provided ample illustration of what ‘running the government like a business’ means in practice. When I write ‘Trump’ in this context it includes the congressional forces and energies his election has unleashed. The first example is the Republicans’ health care bill. Their efforts to pass legislation have been stalled, temporarily at least, in large part over an argument about how free the private health insurance market should be. Obamacare relied on the private health insurance market, but created controls meant to increase the accessibility of insurance and to establish a minimum baseline for what policies needed to cover. Trumpcare’s initial approach reduced some of these controls, but it wasn’t enough for the conservative marketeers, who demanded that all restrictions on insurance companies be removed. These included lifting the prohibition on excluding people with pre existing conditions, as well as ending the requirement that insurance cover basic and essential services such as prescription drugs, mental health care, pediatric services, maternity care, substance addiction, and emergency care. The rationale is that competition between the ‘freed’ insurance carriers will eventually force premium rates down. The reality is that millions will be priced out of the market, and many of those who can afford insurance will have cheaper plans, with high deductibles that cover very few services. In a separate health related action, Republicans proposed a bill called the Preserving Employee Wellness Act. Under this law employers would be able to coerce employees into participating in wellness programs that require genetic testing. What is the point of this legislation? Businesses need to minimize their costs so they can maximize their profits. Health care costs tend to increase faster than inflation and businesses have long been complaining about the drag they place on profitability. Obamacare opened the door to employers pushing employees into wellness programs, saving companies money in the short term by imposing penalties on employees who didn’t participate or didn’t reach health goals. The Republicans’ bill would extend this opening to allow genetic testing. What would this information be used for? Its hard to imagine it being used for anything other than discrimination. Workers testing positive for certain conditions, or the risk of certain conditions, could be denied employment and/or health insurance as employers seek to control health care costs by excluding individuals with potentially costly health conditions. In another recent action, Congress voted to repeal rules protecting the internet privacy of us all. Trump’s appointee as head of the Federal Communications Commission (FCC) enthusiastically supported the change which will allow internet service providers to collect information on every user’s browsing habits, app usage, location data, and more, and to sell that data to whoever pays. For their money, advertisers will be able to fine tune their ads to target individuals based on the profile constructed from the data. Though likely not intended, it will also give hackers much richer targets to steal. And intended or not, it will come in handy for government surveillance to keep tabs on users, whether citizens or not. A last example, is another recent congressional vote, this one to use the power of the Congressional Review Act to repeal an OSHA rule requiring an employer to keep records of workplace injuries and illnesses. Under what was called the Volks rule, OSHA could cite employers who failed to record injuries or illnesses at their workplace during the five years they are required to retain these records. Republicans want the time period limited to just six months. Not only will this change reduce the number of employers who can potentially be fined by OSHA, it has the potential to further distort the real picture of workplace injuries and illnesses. With less reporting, Republicans will argue that workplaces are safer and the need for standards and enforcement requires less resources and attention. What’s the common thread in all of these examples? They show the real meaning of ‘running government like a business’: freeing business from all forms of regulation that impede profitability. Nothing else really matters, not health, individual privacy, worker safety and health, nor coerced collection of genetic information for use in discrimination. The list of things that don’t matter has already gotten longer since I began writing this piece. The question is how long that list will get and what we will have sacrificed for the sake of profits along the way. Those who will believe that our survival and prosperity depends on unleashing the power of unfettered business will be thrilled by the direction Trump and the Republicans are taking us. However, anybody who believed that ‘running the government like a business’ meant something else is in for a rude awakening, if they haven’t been shaken awake yet. Of course focusing on Trump and the Republicans ignores the role the Democrats have played in bringing us to where we are now. But that’s a story for another time. Right now the Democrats are pretty irrelevant. Trump and the Republicans are in command of the moment. "To the Editor" (posted on Syracuse.com 3/23/17)