WHO Funding Controversy in Perspective

Dear Editor,

President Trump was criticized for defunding the World Health Organization (WHO). Many critics supported President Obama’s Affordable Care Act (ACA). The ACA was massive legislation that encouraged wider implementation of medical provider pay-for-performance reimbursement. Under the law, reimbursement is tied to clinical outcomes. If a desired outcome is not achieved, payment is reduced. If an error occurs the provider/organization is then liable for the entire cost of mistake and the care required to fix the mistake.

In the US, high cost of care with low outcomes compared to other countries drove implementation. Many opposition complained about unintended consequences of pay-for-performance. Few media payed attention to the concerns. Pay-for-performance is now standard to improve efficiency. From a systems point of view, it was unwise to continually offer blank checks.

Many scandals have occurred over the past several decades due to lack of oversight of international organizations. International doping agencies and cycling federations ignored and even aided Lance Armstrong. IOC site selection grew more demanding of expensive gifts. China is an emerging economy with money to spend that can silence internal public opinion. Both China and the WHO have little pressure to account for resources. If a country is willing to spend money to bribe the IOC to host games to increase prestige, why won’t one bribe to silence an agency to prevent criticism that reduces prestige? The pandemic is a failure. Something didn’t work out. Withholding funds encourages performance and transparency.

The WHO concerns are eerily similar to ACA affected US providers. ACA supporters argued the change was required to improve quality. The most vulnerable are at greater risk from bad medical outcomes. The president’s actions are required to improve care provided by the WHO. The most vulnerable with least resources are at greatest risk from this pandemic.

The president is treating the WHO as the ACA treats US physicians. He is using the power of the purse to encourage the WHO, which has much less oversight, to improve performance after a catastrophic result. Withholding money today should theoretically encourage greater introspection to improve planning leading to better future outcomes. Using the same logic this encourages performance improvement for those who depend on the WHO the most. It would be irresponsible to ignore this failure and continue to fund blindly. This is not as unusual as it is being portrayed.

Alan Burke