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Looking back, Looking forward

George Santayana, in 1905 said, “Those who cannot remember the past are condemned to repeat it.” This is a good reason for us to look back since many of the proposed changes to healthcare going forward will resemble those of the past, but with some new twists. While the new Administration will probably take some different paths, they will still be focusing on healthcare costs, especially prescription drug prices, and Medicare and Medicaid costs and benefits. They will also be looking to revitalize the Affordable Care Act (often called Obamacare) along with increased transparency in the healthcare supply chain. Some of these changes could be good and some could be bad; it will be my goal in 2021 to parse out the details of each change, explain the impact of each change in plain and simple terms and then identify the best ways we can speak out to encourage the enactment of the good changes and what we can do to stop the bad changes. As always, my focus will be on how these changes affect older Americans.

One of the first things I would like the new Administration to do is to quit using Executive Orders (EOs) to make policy changes. The use of the EO has thrust itself into prominence as a way to change our healthcare. It has been overused and I feel it’s a threat to some of our basic rights. With a sweep of the pen, past presidents have instituted changes that have changed some of the basic tenets of laws that have been passed or have circumvented the rightful legislative process. The elimination of checks and balances is never a good path. When former President Trump issued the Most Favored Nation EO (you can click here and here to read more about this in some earlier blogs) he ventured into a legal gray area that has been stopped by injunction in the courts. It shows another weakness of using EOs.

The misuse of a positive aspect of the Affordable Care Act is another example of a way that past Administrations have bypassed the acceptable path for change. I discussed this in a blog last year. You can click here for more detail. This process, enacted through the Center for Medicare and Medicaid Innovation (CMMI), was meant to test new ways to improve healthcare by developing small, short term, test projects. Past Administrations have tried, and sometimes succeeded, in enacting huge changes by pushing through projects that were nationwide, long term and mandated provider participation. This program misuse needs to stop. We need our elected representatives, our voices in Washington, to be part of any changes that have such a huge effect on our lives.

Drug prices have become the scapegoat for healthcare costs. It has been easy to focus on “rich” drug companies and the list price increases that have resulted from the convoluted business model that supplies our prescription drugs. Past proposals have tried to use foreign prices to force drug prices down. Allowing the importation of unregulated prescription drugs or basing our drug prices based on the drug costs in foreign countries were both ideas that have yet to be implemented. The real solution is simplifying the prescription drug supply line and allowing new ways to price new drugs, like pricing based on the medicine’s success or what savings the medicine produced in the whole healthcare system.

One past change involved setting the price of some Medicare Part B drugs. These expensive drugs are often infused by a doctor in a doctor’s office for sicknesses like cancer and autoimmune deficiencies. Again, this is a sledge hammer approach that will impact many local clinics but will most likely not result in savings for the patient. I think the cost of medicines in Medicare Part B will be a target going forward.

One change that we hope is considered going forward is a yearly cap on a patient’s out-of-pocket-costs for Medicare Part D. This change will eliminate a huge variable that has troubled people as they plan for retirement. It will also help reduce the impact of drug costs on the very sickest among us.

While one party holds the Presidency and the majority in both Houses, the path to legislative changes will be tenuous given the slim majorities in both the House and the Senate. We need to return to the process of having sub-committees and committees debate issues, hold hearings, and have active floor discussions of legislation. It will require some give and take by both sides to pass legislation – that’s the way it should be. We should be able to have our say, have the chance to tell our Representative and Senators how we feel about an issue. We shouldn’t allow changes that use the gray areas of the law, gray areas that can be challenged by injunctions, like the Most Favored Nation Executive Order.

As we look forward to 2021, I hope it will be with a new sense of civility, a return to an open discussion of the merits or faults of an issue. The battle to overcome the COVID-19 pandemic will consume a lot of time and effort, but the battle to ensure that we have access to life improving and lifesaving healthcare will continue. It will be up to each of us to get involved in the process and make our voices heard.

Best, Thair