During a session at World Health Care Congress 2019, Senator Bill Cassidy, MD, offered his alternative to Medicare for All, which is modeled after the Children’s Health Insurance Program, and discussed other healthcare issues on his radar.
During a session at World Health Care Congress 2019, Senator Bill Cassidy, MD, criticized the idea of Medicare for All, arguing that the move would give government power over the patient rather than give patients power over their healthcare. Offering an alternative, Cassidy, R-Lousiana, outlined his vision for allowing states to offer healthcare to their specific populations.
Modeled after the Children’s Health Insurance Program, which is funded jointly by states and the federal government, the plan would move away from a flat rate per patient. Instead, said Cassidy, the federal government would look at a state’s expansion population and individual exchanges and offer adjusted rates based on the health status and demographics of the population. For example, he said, women who are 50 would be cheaper than men who are 50, and children would be cheaper than adults. From there, states would be held accountable for outcomes.
In addition to an alternative to Medicare for All, Cassidy has set a focus on surprise medical billing and price transparency, which has gained support from both sides of the aisle. “You can’t live in our society without being impacted by costs by one way or another,” he said.
He added: “If you have a patient that goes to an in-network hospital, she should not get an out-of-network bill. Nor should she be the point of leverage as the provider and insurer duke it out over how much they should get paid.”
On the point of price transparency, Cassidy noted the administration’s barring of the so-called pharmacist gag clause and envisioned the ability for a patient to be able to scan a quick response code and look up rates of a service throughout the area. He referenced a Los Angeles Times article that unearthed a difference of more than $2000 for the same service within the same area code.
“The only way you knew that was if you were an investigative reporter for the LA Times. That should not be the case,” he said.
Unsurprisingly, the issue of rising drug costs also came to the forefront of the discussion, with Cassidy using emerging gene therapies as an example. We currently have a pricing system where the list price is set by the drug company with no pushback, he said. As a result, gene therapies are being priced at a point where few can afford it, highlighting the need to find a balance between promoting innovation and making up for research costs and ensuring drug competition.
Looking toward Germany, Cassidy explained that the country allows the opening price of a drug to be set by the drug company and after 3 months, there is an analysis of the benefits of the drug and whether the benefits support its price. Analyses from manufacturers, insurers, and other stakeholders are taken into consideration by an arbitrator who determines the value.
“It gives a reward for innovation and the ability to build your case empirically, but if it’s way overpriced, there will be some correction on the backside,” he said.
And this isn’t needed just for first-in-class novel therapies; it’s also needed for generics, said Cassidy, referencing tactics that drug companies use to block generic drug competition when their drug goes off patent.
Although he is a proponent of the International Pricing Index, which would allow Medicare to determine the price it pays for certain drugs based on the prices that other countries pay, Cassidy said he would be open to other ideas if they could address rising drug costs.