After Pandemic Ends, U.S. Needs Recovery Authority
By: Philip K. Howard
Cutting red tape in health care has unleashed waves of energy and ingenuity to deal with the COVID-19 crisis:
Telemedicine became mainstream almost instantly when the U.S. Department of Health and Human Services waived privacy constraints — and approved reimbursement parity—for treating patients at home.
Letting governors design their own testing regimes has removed the bottleneck of centralized federal agencies, dramatically increasing capacity. Liberated from the shackles of lengthy federal procedures, New York Gov. Andrew Cuomo has waived scores of regulations, such as the requirement that the transport of disabled people from state facilities must be “accompanied by same gender staff.”
Easing state medical licensing requirements, which typically prevent doctors and nurses from practicing in other states, has allowed doctors and nurses to care for patients in states suffering from under-capacity.
Once the crisis is under control, the same kind of energy and resourcefulness will be needed to get America’s schools, businesses, government agencies and nonprofits up and running again. What’s needed is a temporary Recovery Authority with a broad mandate to identify and waive unnecessary bureaucratic hurdles to recovery. The public will benefit not only with faster recovery, but also by treating the new approaches as pilot projects for more effective governance.
Government’s delay in containing the virus illustrates a fatal weakness of the modern bureaucratic state — rote compliance with detailed dictates preempts the active human intelligence needed to get things done.
Testing for COVID-19 was delayed for weeks because of mandated bureaucratic approvals. After the first confirmed U.S. case appeared in Seattle, flu researchers conducting a study there were barred from retesting swabs they’d already gathered because of a rule requiring explicit permission of research subjects. Nor could the researchers evaluate the samples without first getting Food and Drug Administration approval of their testing method and getting another agency to certify the lab analyzing the tests.
As the virus spread, official denials and bureaucratic bottlenecks stymied medical centers across America from containing the virus. No one could act without passing through the eye of the bureaucratic needle. Public health officials across the country were prevented from using their own tests, buying them overseas, or using local labs.
Regulations slow life-saving response
The shortages of tests, caused by red tape, then resulted in more red tape to ration the tests at the point of care. As an emergency room doctor in Georgia observed, “We’re … asking thoughtful, knowledgeable medical professionals to jump through hoops to get a test they know a patient needs.”
There’s a paradox here. COVID-19 illustrates the vital need for public oversight and action in an interdependent world, but also illustrates the folly of thinking that rigid rules and procedures are the best way of achieving that oversight.
Looking toward recovery, the regulatory landscape is littered with countless thousands of legal land mines that can be used to skew or prevent expeditious action. For example:
Schools are a hornet’s nest of legal rules. Soon after New Jersey closed its schools as part of the virus shutdown, a parent of a special education student complained that the shutdown violated his rights. Any aspect of a recovery plan that is out of the ordinary—a make-up schedule, or an expedited disciplinary process, or online interaction—can be argued to violate someone’s rights. The regulatory density is virtually impenetrable. One rule that Gov. Cuomo waived is that cleaning products used in schools must “minimize adverse impacts on children’s health and the environment.” It’s more important, as the governor realized, to start cleaning the schools instead of spending months in an approval process.
Small businesses need help. Many small employers will go out of business. The gap will be readily filled by entrepreneurs if they can navigate the hydra-headed regulatory permitting process. Other countries have one-stop shops to expedite approvals and licenses. Starting a restaurant in New York City, former Mayor Michael Bloomberg found, requires permits from upward of 11 agencies.
Government also paralyzes itself. The 2020 stimulus could readily be directed in part to rebuilding America’s decrepit infrastructure, providing several million jobs, as the 2009 stimulus was supposed to have done. But no official in government has authority to expedite permits. That’s why only 3.6% of the 2009 stimulus was spent on transportation infrastructure.
Recovering from this economic coma will require unleashing practical choices throughout the institutions of America. We see it starting to happen. Municipalities are starting to hold virtual town halls. Texas Gov. Greg Abbott has waived rule preventing restaurants from selling their food ingredients to other organizations. He and other governors now allow — hold on to your chair — restaurants to deliver alcoholic beverages along with meals.
It’s impossible to predict where the regulatory tripwires will be. The bureaucratic jungle is too dense — 150 million words of binding law and regulations in the federal government alone. That’s why Congress should authorize a temporary Recovery Authority with the mandate of cutting through red tape so America can get working again.
Source: USA Today