Republicans Still Have No Idea How To Talk About Health Care

Even when they have a good idea, the argument gets muddled.

No policy issue has vexed the modern Republican Party more than health care. Over the last decade, the GOP has decried the passage of Obamacare, a health care law based on a plan developed by a conservative think tank and first implemented by a Republican governor; it has attempted to repeal that law and replace it with legislation that many top party officials struggle to explain; and it elected Donald Trump, a man who in his first presidential run praised single-payer health care and whose administration is currently backing a dubious legal challenge to Obamacare even while promising to preserve many of the regulations that challenge would overturn. The party frequently criticizes government-run health care even as Trump has repeatedly promised to preserve and protect Medicare, the nation's largest and most expensive government-financed health care program. 

The Republican health care agenda is thus not so much a plan as a series of empty buzzwords and phrases—"patient-centered," "preserving the doctor patient relationship," "health care choice"—that do little to describe a coherent set of principles or policy mechanisms. Trump's personal incoherence has further muddled the issue for a party already grasping for direction. 

Even where the party has clear ideas that would advance the interests of individual patients, those ideas are often expressed in such a garbled and disjointed manner that it is difficult to be sure what they are. Take Natalie Harp's disjointed speech last night at the Republican National Convention. Harp, a cancer patient and member of Trump's 2020 campaign advisory board, introduced herself as "a formerly forgotten American." After reading and watching her speech several times, I am reasonably confident that it was intended as an argument for medical legislation known as "right to try." 

It would hardly be surprising to find someone making that case for right-to-try laws in the midst of a Trump-centric GOP convention. One of the most consistent and positive aspects of Trump's health care agenda has been his support for these laws, which give terminally ill patients the option to choose potentially life-saving treatments that have not yet been approved by the Food and Drug Administration (FDA). 

In 2018, Trump signed a law expanding the rights of individuals with terminal illnesses to access drugs that have passed the first stage of clinical trials but not passed complete FDA review. Although the direct impact of federal right-to-try appears to have been limited, it established an important principle: The dying have a right to make crucial decisions about their lives and bodies for themselves. Since then, Trump has repeatedly touted the law in speeches and events, advertising it as a way he has helped expand health care choices for individuals. 

Yet Harp's scattered remarks only briefly touched on the idea behind right to try, thanking Trump for giving her "the right to experimental treatments" and for preserving her "right to try, just like Charlie Gard, that terminally ill British baby, whose government-run health care system decided it was too expensive and too cruel to keep him alive."

Instead of focusing on the potential benefits of Trump's law, Harp offered some token culture-war jabs at Democrats, who she said "love to talk about health care being a human right, but a right to what? Well, I'll tell you. To them, it's a right to marijuana, opioids, and the right to 'die with dignity'—a politically correct way of saying 'assisted suicide.'" And she closed with a rambling ode to Trump's health policy acumen, starting with the coronavirus: Without Trump, she said, "in January, there would have been no China travel ban. Millions would have died, and millions more would have been infected, while there would be no fast-track approval process for a vaccine." Without Trump, she said, drugs would be more expensive and there would be no price transparency. Meanwhile "in Joe Biden's America, China would control our drug production." 

Harp's speech was not a case for right to try so much as a loose constellation of Trump-friendly assertions about federal health policy. Some of these assertions were exaggerated (it is unlikely that "millions" would have died without Trump's China travel restrictions). Others lacked context (Trump's price transparency rules have been mired in legal challenges and don't account for some of the deeper complexities of medical billing, limiting their benefits). Others were speculative counterfactuals based on little or no demonstrated evidence (it's hard to believe that without Trump, China would control drug production and there would be no attempt to accelerate vaccine development). And despite slagging marijuana and opioids, Harp is reported to have experimented with both herself. Even if they proved ineffective for her, it is odd to see someone simultaneously tout the legal expansion of individual health care choices and complain about legal expansions of individual treatments. 

Harp did not even specifically mention Trump's 2018 law or attempt to describe the substance of what it does. (Hence my initial uncertainty about the precise topic of her speech.) That may be because there is scant evidence that she actually benefited from it. 

Although she has credited Trump's right-to-try law for her personal medical successes in the past, a Washington Post piece last year found little evidence to support her claim. Instead, according to her own written account, she received "an FDA-approved immunotherapy drug for an unapproved use." Off-label use of already-approved drugs was legal before the federal right-to-try law passed. It is possible that Harp benefited from Trump's right-to-try law in some other way, or that the account is somehow incomplete. But it is hard to know based on the information available, and last night's speech provided no additional details. The Post article says Harp did not respond to repeated questions about her treatment. 

Harp's speech is thus a perfect illustration of the right's muddled thinking on health care in the Trump era, where even good ideas are often packaged poorly. The right to try is good legislation based on a humane principle: Individuals should have the right to determine their own medical fates, free of government intervention. But that legislation, and the idea behind it, deserve a better, clearer defense than the GOP seems capable of mustering.