Aug. 2, 2017 – Tommy Thompson, former Wisconsin governor and the U.S. Health and Human Services (HHS) secretary under George W. Bush, says the GOP’s inability to enact health care reform creates a “golden opportunity” for bipartisanship.

Thompson is speaking at the State Bar of Wisconsin’s upcoming Health, Labor and Employment Law (HLE) Institute, Aug. 17-18, in Wisconsin Dells. He’ll talk about the health care political atmosphere from the perspective of the country’s top health official.

The four-term Republican state governor served as HHS secretary from 2001 to 2005, overseeing the passage of Medicare Part D (prescription drugs), a contentious bill at the time. He also dealt with 9/11, smallpox vaccination, and the AIDS epidemic.

In preparation for his HLE appearance, Thompson reflects on his experience as HHS secretary and where health care could be headed next.

What do you make of all the politics on health care the last month?

Number one, I think the Republicans really have made some terrible mistakes and should have had a workable plan that had the votes to get through. They didn’t, and that’s their fault. Secondly, Obamacare is dead. It’s not going to go anywhere. Sooner or later, the Democrats will have to realize they should work with the Republicans to get a bipartisan bill done.

Third, the President has the opportunity to either continue the subsidies or not, and to the best of my knowledge, he has not made up his mind yet. But all indications are that he will apply pressure and could accelerate the demise of Obamacare and therefore force action.

Looking back at history, you always have Democrats and Republicans working together when you have big social reforms.

Looking back at history, you always have Democrats and Republicans working together when you have big social policy. You look back at Social Security, you look back at Medicare, look back at Medicaid, look back on Medicare Part D, which I was responsible for – all successful programs by the way – and they were all done with bipartisan votes. Never has there been a really big change on social policy in America without bipartisan support. And so I think that the failure of the Republicans to act gives Congress a golden opportunity. I’m looking at this optimistically as a way to get a bipartisan health care bill through that’s reform minded, that’s affordable and accessible, and treats all the states the same on Medicaid.

I think that’s doable and it’s possible, and I think that will be the result when saner minds come back in the fall and realize they have to get something done.

You mentioned Medicare Part D, the prescription drug benefit that was enacted in 2003 under the Medicare Modernization Act. That was also a contentious period, right?

Very contentious. President Bush told me he promised to get drug coverage for seniors and said it was my responsibility to get it done. And so, my department and the White House worked for weeks on getting that done, and I spent months over in Congress working with the House Ways and Means Committee and the House and the Senate Finance Committee to get a bipartisan proposal done. In the Senate, I had John Breaux [Democrat for Louisiana], and Max Baucus [a Democrat from Montana] and got a bipartisan bill done. I also had some outside advice from Ted Kennedy. He didn’t vote for it, but he gave me a lot of good advice.

What was your philosophy on how to get things done as HHS secretary?

My philosophy never changes. My philosophy is to work with people who want to get things done. I did that as governor and I did it as secretary. If a Democrat wanted to work with me, I said “come on in.” We did it.

What were some of your biggest accomplishments?

The biggest change in AIDS policy was done under the Department of Health and Human Services. We set up the Global Fund, and with President Bush’s leadership, we were able to pass the President’s Emergency Plan for AIDS Relief (PEPFAR). To this day, he will credit PEPFAR as his No. 1 accomplishment in the social arena.

Biggest challenge?

I had 9/11 on my hands and fears of bioterrorism. I had a shortage of medicine. People were afraid that smallpox was going to be the next big epidemic, and we did not have enough vaccine. We went around and found a cache of smallpox vaccine from the 1950s that was locked up in a room at a pharmaceutical company, and we were able to use that vaccine and divide it up so that we could make more smallpox vaccine.

It was finding that cache and finding a way to use it, it was setting up a public health system that had deteriorated, including adequate antibiotics and vaccines. People were really worried about smallpox and monkey pox, and Severe Acute Respiratory Syndrome (SARS). AIDS was running rampant, especially in Africa. We set up the Global Fund and PEPFAR to fight that. I negotiated with Bayer to buy Cipro, an anthrax vaccine, at a percentage of what they were selling it to the public. To my knowledge, no HHS secretary has negotiated with a pharmaceutical company for lower drug prices. 

What is the biggest challenge for HHS Secretary Tom Price right now?

Getting a health care bill done.

But if the Republicans can’t enact a health care bill – which they have not been able to do – is it problematic for Secretary Price to be in charge of a law he would like to see dismantled?  

Obamacare is not going to stay. It just isn’t. It’s falling apart. Congress has got to pass something.

You championed wellness and preventative medicine as HHS secretary. Why do you think ACA repeal and replace efforts have aimed to defund prevention initiatives? Why is preventive health a low funding priority?

Because they don’t understand the importance of it. We spend 91 percent of our health care dollars getting people well after they get sick, and less than 9 percent of that $3 trillion is spent on keeping you well in the first place. We do not have a health system, we have a disease system. I think we should go to a health system.

We do not have a health system, we have a disease system.

I was into wellness and prevention when I was governor, but I really got into it when I became HHS secretary and went down to CDC and did something no secretary has ever done. I spent a week at each of the divisions. I found out that we are killing ourselves through obesity and diabetes, and we were not going to be able to afford it. I decided we were going to prevent diabetes, infectious diseases, and chronic illnesses. Alzheimer’s and diabetes are killing our health care costs. I came to the conclusion that the best way forward was wellness and prevention.

Preventative health has always been a low funding priority. It just always has been. People just don’t understand it. They don’t understand the connection. One thing is the Congressional Budget Office (CBO) has to put a fiscal estimate on it. The CBO does not score something as esoteric as wellness. They can’t score it without a dollar amount.

What was the political atmosphere like when you helped create BadgerCare in Wisconsin?

BadgerCare came as an idea I had when I was sitting on the Joint Finance Committee 50 years ago. I came to the conclusion that if you were middle-income to well-to-do, you could buy a good lawyer if you got in trouble. If you were poor, you got a public defender at the state’s expense.

If you were, like I was then, just on the verge of making a living, small business people that I represented – including farmers working 14 hours per day – those poor blokes never had enough money to hire a lawyer or a doctor or go to get your shots. I didn’t think it was fair. That carried with me, but I couldn’t get anything done while I was in the Assembly because I was always in the minority. That changed when I became governor. That was how BadgerCare came to be.