RUTHFULLY YOURS

Donald Trump may or may not be planning to reorganize the 17 separate U.S. intelligence agencies, and the mere suggestion seems to be a breach of Beltway etiquette. But the intelligence services shouldn’t be immune from a bureaucratic shakeup, especially at the White House, and we have some suggestions.

The Journal reported this week that the Trump team believes the Office of the Director of National Intelligence (DNI) has become “bloated and politicized,” though incoming White House press secretary Sean Spicer called the story “100% false.” The transition also said that Mr. Trump will nominate Dan Coats, a former Indiana Senator and political grownup, as DNI, perhaps to calm the uproar.

Mr. Trump’s opponents are portraying the reorganization as his payback to the intelligence community for concluding that Russia hacked Democrats to throw him the election, and Mr. Trump’s tweets don’t help. “The ‘Intelligence’ briefing on so-called ‘Russian hacking’ was delayed until Friday, perhaps more time needed to build a case. Very strange!” the President-elect tweeted this week, though he later called himself “a big fan!” of U.S. spooks.

This brawling is a shame because the truth is that the DNI has become the stagnant, permanent bureaucracy that critics predicted when the office was proposed in the panicked runup to the 2004 election. The 9/11 Commission identified multiple failures to coordinate activities and share information across the CIA, FBI, National Security Agency and so forth, and the commissioners lobbied for the new DNI as a maestro in the war on terror.

We argued at the time that this “furniture reshuffle” would simply “create a new layer of bureaucracy to police the old layers,” and we hoped we’d be wrong. Better intelligence integration and management is a useful goal, but Congress whipped the DNI bill though with little strategic deliberation. CONTINUE AT SITE

Americans who want better treatments for their diseases should be pleased that the lame-duck Congress passed the 21st Century Cures Act, which will promote medical innovation. They should be wary, however, of the $4 billion budget boost that the law gives to the National Institutes of Health.

The assumption seems to be that the root of all medical innovation is university research, primarily funded by federal grants. This is mistaken. The private economy, not the government, actually discovers and develops most of the insights and products that advance health. The history of medical progress supports this conclusion.

Few findings in medical science significantly improved health until the late 19th and early 20th centuries. During that period came breakthroughs such as anesthesia and antisepsis, along with vaccines and antibiotics to combat infectious diseases. The discovery of vitamins and hormones made it possible to treat patients with deficiencies in either category.

In America, innovation came from physicians in universities and research institutes that were supported by philanthropy. Private industry provided chemicals used in the studies and then manufactured therapies on a mass scale.

Things changed after World War II, when Vannevar Bush, who had led the U.S. Office of Scientific Research and Development during the war, persuaded Congress to increase federal subsidies for science. The National Institutes of Health became the major backer of medical research. That changed the incentives. Universities that had previously lacked research operations suddenly developed them, and others expanded existing programs. Over time these institutions grew into what I call the government-academic biomedical complex.

Since then, improvements in health have accumulated. Life expectancy has increased. Deaths from heart attack and stroke have radically decreased, and cancer mortality has declined. New drugs and devices have ameliorated the pain and immobility of diseases like arthritis. Yet the question remains: Is the government responsible for these improvements? The answer is largely no. Washington-centric research, rather, might slow progress.

Many physicians have never lacked motivation to develop treatments for diseases. But the government-academic biomedical complex has recruited predominantly nonphysician scientists who value elegant solutions to medical puzzles—generally preferring to impress their influential peers rather than solve practical problems. Vannevar Bush believed that basic research, unrelated to specific ends, was the best approach to scientific progress. How something works became more important than whether it works. Aspirin, for example, came into use even though researchers weren’t sure exactly what made it effective. That approach would never work today. Instead of the messy work of studying sick patients, scientists now prefer experimenting with inbred mice and cultured cells. Their results accrue faster and are scientifically cleaner, but they arguably are less germane to health.

President Obama does few favors for Republicans, but he did them a parting one this week when he sojourned to Capitol Hill, where he exhorted Democrats to defend ObamaCare. The vision of the president calling on his party’s members to—yet again—lay down their political lives for his “signature” law was a reminder of how this disaster began. Only if Republicans remember that history do they have a chance of succeeding where Mr. Obama failed.

The media are already labeling the Republican strategy of “repeal and replace” a mess, obsessing over the GOP’s lack of a fully formed “replace” plan. The suggestion is that disorder and disunity reign. This is the same media that all of seven weeks ago was assuring the GOP it needn’t even bother drawing up a bill, since President Hillary Clinton would veto any changes to ObamaCare.

True enough, eight years ago congressional Republicans were clueless about health-care policy. But a great deal has changed in that time—in ideas, education and the quality of the GOP caucus. Witness Rep. (and Dr.) Tom Price, the nominee to be the next secretary of health and human services, who offered in Congress his own detailed replacement plan.

Republicans already agree on the general contours of a free-market proposal—one based on tax credits, entitlement reform, freer insurance markets, portable policies and fewer mandates. The internal debates are over scope and details, not approach.

The bigger point is that what might undo Republicans isn’t policy so much as politics. This is where they’d do well to reflect on all that President Obama did wrong. Long before ObamaCare cratered on the merits, it had failed in the court of public opinion—because of both the manner and the means by which it became law. The first test for Republican lawmakers and the Trump administration is whether they prove foolish enough to repeat those obvious mistakes.

Senior Democrats crafted ObamaCare in lobbyist-filled backrooms, forgoing hearings, markups, even input from their own colleagues—much less Republicans. It was an exercise in secrecy and control. Those now calling on the GOP to present a fait accompli “replace” plan, and to ram it through alongside repeal, are advocating essentially the same high-handed approach.

So yes, it’s imperative that Republicans move to implement a replace plan this year, while they still retain maximum political capital. But they should build in time for hearings, debates, modifications. A coalition must be built. The public needs to know that, this time, the job is being done right.

In 2009 Democrats were so convinced of their health-care righteousness, and in such a hurry, that they never bothered to sell their plan to the public. Many of them probably didn’t even know what they were meant to sell, since they hadn’t read the 2,700-page bill and, per Nancy Pelosi, were waiting to pass it to find out what was in it. CONTINUE AT SITE