Sometimes we forget what an impact Medicare has on our lives. A person has to be around 90 years old to really understand what their life was without Medicare. They would have been 30 years, probably have a young family, and be increasingly worried about their parents’ access to affordable healthcare as they got older or they knew other older people who had medical problems that devastated them financially and/or were forced to rely on their families or their church to help them. They must have worried about what the future held for them and how they would deal with the decline in health that every person faces as they grow old. I was 17 when Medicare was signed into law in 1965 so, for me, it was something that seemed like it was always available. I can’t imagine the relief that seniors must have felt when this new benefit was made available. I talked a lot about the history of Medicare in my blog earlier this month, but I want to repeat a quote from President Johnson’s speech at the signing ceremony,

Medicare’s prescription drug program, labeled Part D, has been one of the most successful government programs ever implemented. After Medicare began in 1965 there were changes along the way (see last week’s blog). One of the things that was discussed then was a prescription drug program, but Congress didn’t get serious until 2003 when it finally became law. It wasn’t easy to get this new benefit passed. I think it might be helpful to look back at how it finally became law.

Sixty years ago, Medicare was born when President Johnson signed it into law. At the ceremony, he gave a great deal of the credit to former President Truman, who had fought hard for this program and even honored him by presenting him with the first Medicare card. In his speech, President Johnson detailed the promises that this new program made to older Americans.

A couple of weeks ago I attended the USAging conference in Chicago, one of several events I attend each year. I go to these conferences to understand and learn about the many programs that support seniors, as well as the ways that our federal, state, and local governments work to aid us as we grow older. It helps me understand the impact of the laws and regulations that our government has passed that affect you and me.

August 1, 2025—Seniors Speak Out, a national healthcare policy advocacy group, issued the following statement on the Senate HELP hearing: “Making Health Care Affordable: Solutions to Lower Costs and Empower Patients.”

It’s the summer recess for members of Congress, a chance for them to go back home and take some deserving time off, but also a chance for them to communicate directly with their constituents - you and me. Early in our country’s history members of Congress went back to their homes to plant and harvest crops and to take care of their property, which usually took them away for 3 or 4 months. I always thought this was a tradition that should be continued . . . it would reduce the number of bills, regulations, and rules that lawmakers could burden us with. Having said that, I do empathize with those in Washington that represent us. The complex society that we live in and the polarization that exists must make it an arduous job where there is a tidal wave of negative influence at every turn. Trying to keep up with the nuance of each issue, working to discern the impact of proposed legislation while weaving in the political implications of a yes or no vote can be tough. Each lawmaker must do this while maintaining a great attitude. I, for one, don’t understand why anyone would run for public office but I respect them for the work they do. I may not agree with some, but I do respect their work.

I’ve written about this piece of proposed legislation earlier in a somewhat, OK real, derogatory way, but Strengthening Medicare and Reducing Taxpayer Prices Act – or SMART Prices Act - continues to raise its ugly head. I thought that maybe it had died a quiet death, but it was reintroduced in the Senate on May 21^st. You can read about it in more detail in my earlier blog, but, in a nutshell, this is what it does. It was introduced originally just after the Inflation Reduction Act (IRA) was passed and it doubled down on the prescription drug price fixing part of the IRA. The SMART Prices Act increases the number of drugs eligible for negotiation from 10 to 20 in 2026, and from 15–20 to 40 in 2027. It also shortens exclusivity periods, reducing the time before drugs become eligible for negotiation from 7 or 11 years down to 3 years, depending on the drug type. These huge changes were proposed back then without a thought of waiting to see what the impact of the initial price fixing would be. You would think that the dire impact on innovation that has already occurred in the almost 3 years since the law was implemented would be enough to scare lawmakers, but that didn’t faze them at all, and I think now it could be even more damaging.

As I’ve attended conferences and stayed abreast of healthcare issues, a new phrase has begun to surface – health span. It certainly caught my attention, and I began to dig into this new (at least new to me) concept. We all know what life span means, the time from our birth to our death. We use that term mostly when we are talking about the average or projected time that a group or category of people will live. We’ve all heard ads that tell us that doing certain healthy things will help us live longer or how medicines and certain procedures will lengthen our lives. Our average life span is longer because of these new medicines and procedures but what is the quality of life in this prolonged life? That’s the crux of health span. Our health span is the number of years we spend in good health, without any of the chronic conditions or disabilities that are often part of aging. That really is an important difference.

At the end of last week our lawmakers passed the One Big Beautiful Bill (OBBB) that has demanded the focus of Washington for weeks spilling into months. This bill is part of the budget reconciliation process which was put into place by the Congressional Budget Act of 1974. It was instituted because lawmakers became less and less interested in compromise and they needed a way to get around the 60-vote requirement to override a filibuster in the Senate and pass a budget with a simple majority. To highlight the non-functional status of Congress, this budget should have been completed by September 30^th of 2024. Congress has not passed a budget on time since 1997 and has only done it four times in the last 50 years, which I think is deplorable. Ok, I got that out of my system, let’s find out how the OBBB impacts you and me.

Last week’s blog talked about the BIO convention, and the most important message I brought home is that policy must never hinder innovation. Greater access to care depends on continued innovation—one cannot exist without the other. It is up to us to ensure lawmakers do not jeopardize America’s position as the global leader in pharmaceutical innovation. When people blame “big Pharma” for limiting access to medicines, it is always focused on the price. We need to remember that the most limiting factor to access is when a drug is never discovered. This week, I want to detail some legislation that needs to be passed, either in the One Big Beautiful Bill (OBBB) that is working its way through the legislative process, or in the near future to support the goals outlined above. It seems these days all legislation is complicated, but I will do my best to demystify and explain the legislation and regulations that are important to you and me.

I’ve attended most of the BIO (Biotechnology Innovation Organization) conferences over the last 15 years and each one is unique. While it is a great place for bringing together all of the different businesses involved in the biopharma eco system, it has also proven to be a valuable resource for those of us interested in public policy. It has always been a place where some of the brightest minds meet to better understand the impact of policy changes on the world’s healthcare.

Last Thursday, June 12^th, we held another Facebook live event. It was a little bit different than our previous events, which usually were centered around public policy issues. This time we hosted a discussion with Nabil Chehab, Medical Affairs, Head of the Lung Cancer Franchise at AstraZeneca, and we discussed innovation in cancer care and the next wave of progress in treatment. It was a joy to talk with Nabil about the people who are working diligently to find treatments and cures for the diseases that have such an impact on our lives. You can watch a recording of the event here, you don’t need a Facebook account to see the video.

President Trump has issued a blizzard of Executive Orders (EO), everything from tariffs that affect our countries dealings with many other countries to orders that our aimed solely at certain universities. I won’t bother you again with all the reasons I dislike Executive Orders except to say that they circumnavigate many of the checks and balances of our Constitution and thus almost all of them have garnered legal challenges that assert President Trump has exceeded the powers of his office.

This month is Alzheimer’s and Brain Awareness month, and it is a chance to talk some more about something that trouble’s everyone of us as we grow old. I’m speaking on my own experience, but I will bet dollars to donuts* that most seniors feel the same way. I’ll go out on a limb here and say we all are constantly in fear of “losing it” and are quick to point out someone else that’s losing it. We use that phrase to describe someone whose actions are giving the indication that they are experiencing something more than just the normal forgetfulness and idiosyncrasies of growing old . . . that they may be suffering some sort of dementia. Virtually all of us have had some experience with someone who has some form of Alzheimer’s or dementia, and we are fearful that we might become afflicted with this personality and memory robbing disease, and it really scares us.

I certainly didn’t coin that phrase, but I might have been the first to use it when I referred to how our government often operated when it came to our healthcare back in 1996. More recently I used it in this blog in 2021 as we were facing President Biden’s trek toward making big changes in our healthcare – including to Medicare Part D. I don’t want to brag (every time someone says that, the very next thing they do is brag, which, with a nod to tradition, I will precede to brag) but the five things that I pointed out in that blog have in many ways come to fruition. I would like to revisit those things and see what we might learn and how they might help us predict how best to move forward, but before I do that, I need to rant a little about why we need to limit our government’s insertion into our lives.

The last Monday in May is Memorial Day, and, contrary to the current tradition, it is not only a holiday to have a plethora of Memorial Day sales. It’s a day to honor those who served and those who died serving in our nation’s armed forces. Its origin goes back to the civil war and, unfortunately, we’ve had multiple wars since then that have cost the lives of many brave men and women. It is a time when I reflect on those I served with during my service in the Air Force.

May 16, 2025—Seniors Speak Out, a national healthcare policy advocacy group, issued the following statement in opposition to the Administration’s Most Favored Nation (MFN) Executive Order (EO):

Since 1949 May has been Mental Health Awareness Month. I can safely say that the perception and reaction to mental health has changed exponentially since 1949, but it hasn’t been a swift transformation. Our healthcare system has slowly begun to recognize that mental illness can be treated and that there are answers to enable folks live productive lives. Historically, there was a huge lack of facilities and trained providers to treat the mentally ill. I remember actively advocating, 25 years ago, for insurance companies to increase, or in some instances just to start, the coverage of mental disorders. It was seen as a huge cost, fraught by fraud and abuse, that would skyrocket premiums. In some cases, it took more stringent government laws and regulations to force the coverage of patients with mental illness. We are doing much better now to cover the costs. But one of the biggest barriers to overcome was the stigma toward mental illness.

I would have never guessed that someday I’d be writing a blog about tariffs. I do remember President Trump during his campaign talked about how unfair other countries tariffs were, but I didn’t imagine how he would approach changing them. As a champion of the free market, I’ve always been against anything that built barriers to the free exchange of goods and services. The President was of this thinking in his first term when he helped close a free trade agreement between the U.S., Canada, and Mexico. I believe that the tariffs imposed by other countries are just a way for them to make quick profits because of manufacturing, geological or political advantages. This approach is not conducive to long term efficiency and doesn’t promote price competition. I hoped that when President Trump won the election, he would institute structured and meaningful steps toward eliminating these inefficient and damaging tariffs. 

Last week I attended the yearly American Society on Aging conference. I’ve agone to this conference for years and have always found it a great place to stay in touch with those who serve older Americans. The theme of this year’s conference was ageism and culture, focusing on identifying and eliminating ageism in all our dealings. It certainly was an honorable theme but, as you might imagine there was a palatable anxiety given the uncertainty that has enveloped our healthcare institutions as they react to the first 90 plus days of the new administration. There were people who had seen valued colleagues who took early retirement, lost their jobs to a reduction in force (RIF), had their whole office dissolved or absorbed into another office or were fearful of losing the funding or grants for their office. There were businesses that were fearful that big changes would make their future plans obsolete. The concern was evident and often took over the discussions in many panels and seminars, but surprisingly it didn’t seem to cause a paralysis of action. From what I saw, even in this time of uncertainty, support for older Americans stands pretty solid, both now and in the future.