Wartime Governor

by Chris Braunlich

If Donald Trump is a “wartime president”, Ralph Northam is now a “wartime governor.”

Unless one has been isolated on a Pacific isle (or wears tinfoil hats to block evil radio waves), Virginians understand that the pandemic we are in is deadly serious, growing exponentially, and requires radical steps to reduce its disastrous effects on our health and our economy. Unlike Nazis during World War II, COVID-19 has already landed on our shores.

But like World War II, mobilizing to fight our new enemy requires redirecting large numbers of resources. And winning will take “not playing by the rules.”

In the last 75 years, government has done what Thomas Jefferson, in the Declaration of Independence, accused King George of doing:  “… erected a multitude of New Offices, and sent hither swarms of Officers…” in the form of a regulatory regime designed to protect Americans from abuses and from each other.

In fighting a common enemy, those rules and regulations serve mostly to hinder. The answer is better found by freeing up those regulations, permitting flexibility, and waiving requirements in key areas needed to win. And, by all accounts, Virginia’s Governor – when emergency powers are invoked – can cut through those regulations.

Prime among these is freeing up resources to be more flexible in delivering care. COVID-19 cases will soon overwhelm our hospitals. Patients normally treated there will be moved back to their homes. Health professionals will start to fall ill themselves. “Regular check-ups” will temporarily become a thing of the past, as doctors strive to minimize visits to their waiting rooms.

Steps should be taken to ensure telemedicine is expanded as broadly as possible and, correctly, Governor Northam recently expanded telemedicine services to include full Medicaid reimbursement. Licensure reciprocity should be instituted so doctors and nurses licensed in one state can practice here (including and especially through telemedicine).

Pharmacists should be permitted to test for and provide medication for non-chronic conditions (i.e., strep and flu), and to make non-narcotic medicine refills available without new prescriptions on a limited emergency basis, as well as to give the coronavirus test when more inevitably become available. They are already trained to do this testing: They are simply not permitted to do it in Virginia. And they may need some funding assistance to obtain the machines.

To backfill medical professionals who will eventually be forced to self-quarantine, retired nurses and doctors should be invited back to work for lower levels of care, whether their licenses are up to date or not.

But since that population is also the one most at-risk, we should also go to the other end of the generational spectrum. Just as military officers graduated after only three years during WWII, doctors and other health professionals in their last year of medical and nursing school should be allowed to practice several months early – perhaps even graduate early. They may not be ready for surgery or detailed oncology plans, but they could free up experienced doctors for more difficult cases in hospitals. The Governor has now started moving in that direction.

Full practice authority should be offered to advanced practice registered nurses with added skills (i.e., nurse practitioners and anesthetists, midwives and clinical specialists), and be able to practice to the full scope of their education, training and certification. They have the knowledge but, like pharmacists, they are not permitted to use it in Virginia.

Post-9/11, Virginia organized a Medical Reserve Corps. But those medical professionals need to be compensated and, just as important, conflicts with the state’s “Good Samaritan law” (which applies only to uncompensated Virginians) need to be swiftly resolved in order to maximize its effectiveness.

Short on supplies? In an action reminiscent of WWII industry switches from adding machines and wheelbarrows to automatic pistols and ammunition carts, Virginia’s Alcohol and Beverage Control Board is giving distillers permission to switch from vodka to hand sanitizer. The Governor and regulators should set the tone by making it clear: Innovation encouraged here.

All of this can be done … mostly through the powers given a “wartime governor” in a state of emergency, or by requesting CMS Section 1135 waivers from the federal government – in this case, an Administration with plenty of disdain for regulations serving as barriers to commonsense. None of them need be permanent; all of them are needed to win.

Finally:  Will some take advantage of that flexibility? Yes. Will mistakes be made? Yes. But the consequences of doing nothing far outweigh those of doing something.

Against an unseen enemy, we’re told there’s a war.  Let’s act like it.

Thanks to Bacon’s Rebellion blogger James Sherlock and former Delegate Dr. John O’Bannon for their ideas, insight and review. Chris Braunlich is president of the Thomas Jefferson Institute for Public Policy.

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14 responses to “Wartime Governor

  1. … and yet, I cannot get Texas Lt. Governor Dan Patrick’s Fox interview out of my thinking on this. He suggested for the over 70 crowd to willingly sacrifice themselves on the altar of the Free Market to save the economy for their young’uns by allowing withholding treatment, i.e., ventilators. Conveniently for him, he is 69.

    But, it is bothersome that he would allow our older Boomers and the remnants of the Greatest to drown horribly and painfully in their own body fluids by the mere chance of infection.

    Instead, let us invoke a “Logan’s Run” approach. We could more humanely dispatch our retirees, pit-bury them, raise a glorious monuments, and restore the 30,000 Dow in a week’s time.

    This IS the solution. It achieves everything.

    For the epidemic;
    1) it frees up the potential of a large draw on the ICU capacity, and
    2) it eliminates 40 million potential carriers of the disease. win-win

    For the economy;
    3) it is a huge transfer of wealth to Gens X and Y, who are more likely to consume manufactured goods over just medical supplies and Depends,
    4) it instantly reduces the strain on corporate and State retirement plans, and
    5) it gives investment capital to the more risk capable 40-somethings, who are likely to choose stocks over annuities.

    Finally, for the government, it resets and eliminates the need for 20+ years of SocSec and Medicare payments, which can be used to pay down the debt and give to the military.

  2. https://www.danpatrick.org/tucker-carlson-tonight-march-23-2020/

    So after hearing about this awful statement, over and over, I went to the source, the Tucker Carlson interview. Oddly, Patrick is saying something that I said in a comment last week. This is going to become like the “Trump called the virus a hoax” lie which has gone (pardon the pun) viral, even though he never said it. Lt. Gov. Patrick’s comments in context are certainly debatable, but hardly a demand that we all go sacrifice ourselves….

    You are going to be surprised how strong this sentiment really is. But in truth, there is also an element of overreaction, an assumption that our depressed portfolios (for example) won’t recover. I’m convinced that it will be just like 08-09, and within years we’ll roar past the previous highs.

    • okay, I’ll go with that. First then, to assure my grandkids have a better world than the one I had, raise minimum wage to $12+/hr. That would be the same buying power I had. Then, lower tuition and cap rents so that a person working 1800+ hours per year could graduate from a State school debt free.

      But, I still like a purge.

    • Questions:

      Will the next great purge be that of America’s managerial class whose failures over past three decades are now on full display, starting with health care, higher education, big government, national and international politics and globalism?

      Is what we are watching unfold now Arlington County’s $Million Dollar Bus Stop on Mega Global Steroids?

      Will America’s elite (its managerial, academic, and high policy intellectual class and their political operatives) get eaten by the monster they designed, built and have foisted on Americans for the past three decades, bilking, abusing, humiliating, and now grossly failing its working class the entire way.

      Or will the elite fool Americans all over again, get away with disaster, scot-free.

    • No question, Nancy, it’s been a mistake to leave the minimum wage stalled for this long, and gradual changes over time would have had little negative effect. Jim and I have been railing about the cost of higher ed for years, and it was a constant message from me when I was on SCHEV. GA had called for another zero-increase year, which is progress, but that’s in jeopardy now.

      • The Strategic Investment Fund should fund these losses if UVA cannot find the means to:

        1. cut its gigantic and bloated overhead and costs,

        2. cut its tuition since few now can afford today’s rates, and

        3. UVa needs to get a serious long and short distance learning program going to save costs, and

        4. UVA needs to refund to taxpayers its share of $1.5 trillion in Higher Ed student loans that now quite likely will fall like a rock on US national treasury, along with all else payable.

        For elite higher education the gig is up, the party over.

  3. I disagree wholeheartedly with the section on pharmacists. My wife is a practicing pharmacist at America’s largest pharmacy/insurance/benefits manager. She couldn’t even store use a bottle of hand sanitizer for the pharmacy. They are working with little to no policy implementations to protect them, and are still dealing with customers upset when staff doesn’t want to let them hand them insurance cards and the like directly, complaining they’ve been discriminated against. My wife is pregnant, placing her at high risk anyways, and we have a small child at home. We are both nearly sick with worry she will catch it as is. Pharmacies are not equipped, staffed, or setup to be doing medical testing for the coronavirus. They have no PPE, and pharmacy techs earn $12 an hour after passing a test you can study for on the Internet and pass. They are not trained nurses, nor a substitute for them. Medical professionals and pharmacy companies have treated them as nothing more than pill dispensers, and that’s all they are setup to be. My wife has a doctorate, but she’s hardly paid like one, nor is she treated as a peer by any medical doctors. Don’t try to treat them as a medical professional now that there is a pandemic. If they start sending suspected Covid19 patients to pharmacies for testing, I expect to see a mass exodus. I for one will definitely be considering telling my wife to quit and she can try to hire back on when this is all over.

  4. Northam is a wartime governor in the same sense that Capt. Crunch is a naval commander.

  5. Steve H, Trump may not have said it’s all a hoax but he sure has acted like he wants people to think that’s what he believes — at least until recently — and even then he undercuts himself daily (back in church on Easter? Sure!!). Patrick’s comment, on the other hand, was a bluntly-stated bottom line from a legitimate policy decision fork in the road: do a bunch of elderly, retiree lives outweigh wrecking the economy? There is a huge incremental cost either way. Of course, spreading the peak out means greater economic damage and longer delays in ordinary health care for everything else our health system treats. Of course, the death rate for the elderly who get this virus but can’t get the health treatment they need, is much higher (estimates of 10% versus 1%). That’s the choice. The questions that linger with me:
    How much is a life worth? Will the economy recover reasonably quickly either way and what can we do now to help that? Will we fix our health care system for the better when this is behind us?

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