February 27, 2020
The American Prospect, February 27, 2020
The COVID-19 coronavirus is nearly a global pandemic. The Centers for Disease Control’s latest statement warns Americans “to prepare, in the expectation that this could be bad.” Amid a global crisis like this, the public needs true leadership from the president and his top aides, and a highly competent government deserving of the people’s trust, with the capacity to effectively respond to incoming threats.
But this is the Trump administration. So instead, we are being asked to put our faith in inexperienced political cronies, servicing the needs of corporations rather than the public, and contemptuous of science, scientists, and the idea of expertise. Whether Democratic candidates or debate moderators recognize it yet, this election will be a referendum on coronavirus response, and by association, how the executive branch should be staffed.
The roots of this crisis go back years and reflect deep-seated enmity to government experts. Each subsequent presidential budget has included ever more draconian, inhumane, and downright offensive cuts to the most basic government services, including those that would leave us prepared to take on a global pandemic. In 2017, Trump tried to slash the Centers for Disease Control’s budget to levels which a former director called “unsafe at any level of enactment.” In 2018, onlookers warned that Trump was “setting up the US to botch a pandemic response.” And in 2019, he went ahead and fired the government’s entire pandemic response chain of command.
Even as the coronavirus spread, the administration was suggesting deeper cuts to the Centers for Disease Control and the National Institutes of Health. And from the outside, commentators at the Heritage Foundation were cheerleading the president’s suggested budget cuts, while encouraging the administration to go further.
Whether Democratic candidates or debate moderators recognize it yet, this election will be a referendum on coronavirus response, and by association, how the executive branch should be staffed.
While the budget proposals reveal administration priorities, so do the men and women Trump has empowered. Principal among them is a man whose primary qualification appears to be a lifelong devotion to enriching Big Pharma.
When President Trump announced former pharmaceutical executive Alex Azar as his nominee for Secretary of Health and Human Services (HHS), Azar’s colleagues in the pharmaceutical and health insurance industries felt relief that they had a friend in the Trump administration. Trump called Azar “a star for better healthcare and lower drug prices,” but the pharma and health insurance execs knew better: Azar’s expertise lies in jacking up medicine prices, not public health or research.
Azar parlayed political positions within George W. Bush’s notoriously corporate-friendly HHS into a lucrative Big Pharma gig. In 2007, Azar oversaw an HHS investigation into Eli Lilly for illegally marketing a psychiatric drug to nursing homes and assisted-living facilities. Shortly thereafter he left for a job as … Eli Lilly’s top lobbyist and spokesperson. Azar became president of Eli Lilly’s U.S. affiliate in 2012, and under his watch the company proceeded to triple the price of insulin.
But while Azar has proven himself effective at cashing in government experience for a big paycheck, nothing in his résumé qualifies him to be the head of the president’s coronavirus task force. Azar’s role includes mobilizing HHS’s many divisions in a crisis, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Until very recently, he didn’t even seem to be trying. Even as the scale of the crisis became clear, Azar was faithfully defending the administration’s budget cuts of 10 percent for HHS and 16 percent for the CDC.
Azar’s first big task-force decision was to partner with the State Department to overrule the administration’s own public-health experts and fly a cruise ship full of patients home instead of treating them in Japan. Questions have been raised about the motivations for that decision. Meanwhile, under questioning from Congress, Azar even failed to guarantee that any vaccine for the coronavirus will be free or cheaply available to all who need it. “We can’t control that price, because we need the private sector to invest,” Azar told Representative Jan Schakowsky (D-IL). “Price controls won’t get us there.” Even in crisis, Azar cannot shake the profit-above-all ideology that dominates his worldview.
Azar does not appear to have the respect of the fellow officials he is supposed to lead on the interagency task force. For example, Azar and Seema Verma, the current administrator of the Centers for Medicare and Medicaid Services, have fumed at each other for months in a public leak war, which one official said is turning federal health policy into “a fucking soap opera.”
Verma has devoted herself inside the Trump administration to depriving poor people of health care, as she did on the outside, hobbling Medicaid for Republican governors in Indiana, Ohio, and Kentucky. But the failure to repeal and replace Obamacare has led to finger-pointing, and rumor has it that this has driven the spat.
Last fall, Azar tried to keep Verma from riding Air Force One to the signing ceremony for an executive order her office helped draft. Verma also blames him for several unflattering news stories, like how she spent millions of taxpayer dollars trying to get on the cover of Glamour, and how she requested almost $50,000 in reimbursements for stolen jewelry. It’s so bad that Vice President Mike Pence had to scold them in the Oval Office like children.
Now these two must work together to manage a health crisis on a scale the nation hasn’t seen in a decade. Yet their personal relationship is so bad, aides have been planning for one or both to be shown the door since last December.
Under questioning from Congress, Azar failed to guarantee that any vaccine for the coronavirus will be free or cheaply available to all who need it. Even in crisis, he cannot shake the profit-above-all ideology that dominates his worldview.
Verma’s not even the only staffer in a grudge match with Azar. Former Gilead lobbyist and current director of the Domestic Policy Council Joe Grogan has made a habit of superseding the chain of command to kill Azar’s projects, including a “rebate rule” favored by the pharma lobby. But progressives shouldn’t count Grogan as an ally: He opposed several Azar plans to cut drug prices, pushed past Attorney General Bill Barr (!) and VP Mike Pence (!!) in his enthusiasm to kill the ACA, and is pushing a pricey reimbursement policy for the cancer drug CAR-T, which his former employer just happened to start selling right after Grogan joined the administration. His biggest asset in the White House is his longtime fealty to acting Chief of Staff Mick Mulvaney, and willingness to boast about Trumpian accomplishments like how “No administration has come in and cut regulations the way we have.”
Grogan and Mulvaney have spent their time during this critical period trying to pin any negative consequences from the COVID-19 response on Azar, blaming him for failing to protect Trump and asking for too much money from Congress to contain the threat. The eventual request of $2.5 billion in emergency funds was seen inside Congress as pathetically low, especially as it sought to pilfer funds from a program that provides heating to poor families. The whole escapade reflects the Trump administration’s guiding principles in action: Take from the poor, give to the powerful, fight amongst yourselves, but never question the boss.
This has all gone so well that Trump appointed Vice President Mike Pence to lead the coronavirus response, effectively demoting Azar while leaving the task force in place. While this was being announced and Trump was downplaying the threat, the first confirmed U.S. case in someone with no known contact with an infected person was announced.
The incompetence and greed of this administration could now literally cost many Americans their lives in a major public-health crisis. But it should also serve as a reminder to 2020 Democrats that they have both tremendous tools in their belt as president, and a tremendous job ahead of them making those tools effective again. Public-health agencies have the raw power needed to contain a threat like the coronavirus, but they can only do so if actual experts with strong civic values lead them—and if they aren’t being undermined by libertarian ideologues from within, nor submitting to attacks from without.
The stakes of rebuilding the executive branch are literally life or death, as the coronavirus demonstrates. Yet this task, the thing which the next president will spend most of their time actually doing, has received almost no attention in the Democratic debates (despite our best efforts to bring it to the forefront). Journalists, activists, and candidates need to talk more about rebuilding the White House’s effectiveness and regaining the public’s trust in the executive branch. If they do not, we can expect many more crises on the scale and tragedy of the coronavirus.