OPINION: Beneficial health care laws the next Congress may (actually) pass

Why does The Fulcrum feature regular columns on health care in America?

US healthcare spending grew 9.7% in 2020, reaching $4.1 trillion, or 19.7% of gross domestic product. In the long term, this is clearly unsustainable. If The Fulcrum is to fulfill our mission as a place for informed discussions about fixing our democracy, we must foster conversations about this vital segment of the economy. Maximizing the quality and reducing the cost of American medicine will not only improve people’s lives, but also generate the dollars needed to invest in education, eliminate poverty or other critical areas. This series on breaking the rules aims to achieve this goal and highlights the essential role that government will have to play.

Pearl is a clinical professor of plastic surgery at Stanford University School of Medicine and on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.

As the 2022 midterm elections approached, health care was once again a top issue for voters, ranking third behind inflation and abortion. But will his prominence among voters translate into policy shifts in a divided Congress? It depends.

Subscribe to the Fulcrum newsletter

For voters whose hearts are set on highly partisan pieces of legislation — like Medicare for All, popular among progressives, or raising the Medicare eligibility age, as some Republicans want — there is no no chance.

But, despite narrow majorities in the House and Senate, Congress can still pass some very beneficial legislation over the next two years. To understand what policies are at stake, one must see where the health care agendas of the two parties overlap.

With that in mind, here are three health care improvements that the 118th Congress could enact:

---

Lower drug prices.

The Trump administration has pushed congressional Republicans to cap drug prices, narrowing the gap between what Americans and Europeans pay for the same drugs. The Biden administration, meanwhile, rallied Democrats on the Cut Inflation Act, part of which allows the federal government to negotiate the cost of the most expensive drugs.

To capture the momentum and public support for lower drug prices, a variety of bipartisan bills have already been introduced.

An example is the Prescription Drug Pricing Dashboard Act, sponsored by Republican Senator Susan Collins and Democratic Senator Bob Casey. The bill “would improve transparency and help reduce costs by requiring that constantly updated information be posted on the Centers for Medicare & Medicaid Services drug spending dashboards,” according to a press release.

If Congress could pass a bill like this for Medicare patients, it could certainly go further and require price transparency for all drugs sold in the United States.

Just as hospitals are now required by law to list the retail price of inpatient services, Congress could require all pharmacies to list the price of their drugs. This would allow patients and their doctors to compare the prices of the best deals before filling prescriptions.

Develop health technology.

As the nation went into lockdown during the initial peak of Covid-19, Congress eased several telemedicine restrictions with overwhelming bipartisan support.

For example, the two sides eagerly removed interstate licensing laws that once prevented a doctor from, say, Chicago from doing a telehealth visit with a patient in northwest Indiana, just a few miles away. (even though those same patients could legally get into a car and drive across the border for in-person care).

The transition was surprisingly smooth. Patients reported almost no privacy or quality issues. In fact, most were grateful for the convenience and opportunity of telehealth and, according to numerous studies, continue to want more of it.

And yet, many states are rolling back policies that have made it easier to access virtual care throughout the pandemic, creating a potentially dangerous setback.

Congress could step in by permanently easing outdated restrictions on telemedicine.

Such policies would make a huge difference in tackling the country’s mental health crisis. Even now, most qualified therapists cannot offer virtual therapy to existing patients who are relocating or even temporarily traveling out of state. Given the shortage of mental health professionals and the growing demand for their services, bipartisan support for telehealth would benefit the psychological well-being and physical health of our country.

Boost primary care.

The United States faces a projected shortage of 17,800 to 48,000 interns and family physicians by 2034.

According to a recent Stanford-Harvard research collaboration, this shortage will have a huge impact on the health and lives of patients. The study found that adding 10 primary care physicians to a community increases patient longevity 2.5 times more than adding an equal number of specialists.

If Americans want to live longer (as well as lower health care costs and better access to care), adding primary care physicians is the answer.

These doctors specialize in finding and preventing diseases (like cancer and kidney failure) before they become a major problem. They also work closely with patients so that existing chronic conditions (like diabetes or hypertension) don’t turn into a costly or even life-threatening medical crisis (like a heart attack or stroke).

Last year, more than 1,000 doctors graduated from accredited medical schools but did not have a residency match. This is because there were not enough training positions available in the United States under the government funded program.

Congress can solve this problem with a small investment – ​​an investment that will reap huge rewards. The cost of training 1,000 additional primary care physicians per year would represent about 0.1% of Medicare’s current budget ($700 billion).

Plus, those dollars would be recouped many times over in the future, as patients need fewer emergency room visits, hospital admissions, and interventional procedures.

As we now know, Covid-19 has disproportionately killed Americans with two or more chronic illnesses. These data have cast a bright and unflattering light on our nation’s inability to effectively prevent or manage patients with diabetes, hypertension, or obesity.

Hiring and training more primary care physicians would begin to fill this gap. Bills like the Resident Physician Shortage Reduction Act and the bipartisan Physicians for Underserved Areas Act indicate that there is interest in solutions on both sides of the aisle.

Democrats and Republicans may approach health care policy with different philosophical grounds. Progressives are more concerned with expanding access to care — especially for vulnerable populations — while conservatives want to limit unnecessary spending.

But regardless of their health care ideologies and despite the political divide, congressional leaders can enact bipartisan policies that would help millions of patients. I urge elected officials to seize these opportunities.