We’ve been reading about the postponement of elective surgeries for the duration of the COVID crisis. This is to make available medical care for patients with the virus.
But most of us may not understand what qualifies as elective surgery. It is not eyelid lifts or other procedures we simply decide to do.
Former Senator and Democratic governor of Nebraska, Bob Kerrey explains in a must-read piece in the Wall Street Journal that elective surgery includes treatments for cancer, heart disease, and other procedures that are far from optional.
After a ban on elective surgery was urged on March 14, 35 states adopted such bans. CMS Administrator Seema Verma announced that is being relaxed, and Kerrey says that this came “not a moment too soon.” Kerrey explains:
The term “elective” is misleading. It doesn’t mean “unnecessary” but “capable of being scheduled.” The result of these orders is that Medicare, Medicaid and commercial health-insurance companies won’t reimburse patients for most surgical procedures that don’t require overnight stays, including diagnostic biopsies, wound care, removal of tubes, and treatments for heart disease, cancer, vascular conditions and orthopedic ailments.
According to a survey of state hospital associations, the daily reduction in revenue is $1,600 per bed. Not counting the increased cost for hot spots like New York and New Jersey, this implies a contraction of $45 billion a month for hospitals, which have been forced to furlough nurses, technicians and other workers. Ambulatory surgical centers are simply closing their doors.
According to Kerrey, this problem can be remedied:
It should be relatively easy to reopen ambulatory surgical centers. They aren’t seeing coronavirus patients, and they typically operate 12 hours a day and provide safe, sanitary and effective off-campus locations to deal with outpatient demands.
Hospitals deal with infectious disease as part of their normal routines and know how to minimize risk to patients and employees. In addition to careful and regular monitoring of the Covid-19 health status of patients and staff, it will be critical to designate wards and procedure rooms, work flows and, when possible, the transit paths to and from these areas, according to Covid status.
Kerrey further argues that, if hospitals eventually adopt the “certificate of immunity” practice, larger hospitals will conduct their own tests. If this happens, Kerrey writes, it will be necessary to “overrule” some existing federal, state, and local rules, including employment contracts.
The bottom line:
Getting the hospitals open won’t cost taxpayers anything. It will save money and lives. We all make mistakes, and this one is understandable. It won’t be understandable if officials fail to correct it.
What Kerrey seems to be recommending is a relaxation of regulations rather than piling on more. Interestingly, Chris DeMuth, distinguished fellow at the Hudson Institute, notes that the Trump administration has been unusual in that it has responded to the crisis with decentralization and deregulation.
Washington’s response to the Covid-19 pandemic is upending one of the most durable patterns of American politics. Throughout history, national emergencies have led to a more powerful and centralized federal government and to the transfer of federal power from Congress to the executive branch. This time, the federal response rests largely on state and local government and private enterprise, with a wave of deregulation clearing the way. The Trump administration has seized no new powers, and Congress has stayed energetically in the game.
The historical pattern is powerful and might have seemed inevitable. In times of war, natural disaster and economic upheaval, action is king. The president and his officials and agencies can act with much greater dispatch than Congress can. They may be forgiven for crossing statutory or even constitutional boundaries—in a crisis, the test of legitimacy is perceived effectiveness. But emergency actions often set precedents for normal times.
The COVID crisis has been a public trauma. But perhaps, when we are back to normal, the crisis will have revealed that many of our byzantine regulations hinder rather than helping.