Every day that the partisan rancor over the 2020 presidential election drags on, it poses a challenge to our nation’s well-being. As the candidates and pundits escalate their rhetoric, more Americans lose faith in our political process. Many get angry. Others check out entirely. Even though 2021 is not an election year, it threatens to become the year more voters than ever become disappointed in their elected representatives and disenchanted with the political process.
Unfortunately, our elected leaders’ legislative agenda thus far has not focused on the issues that voters named as their top concerns this election: essentials like healthcare and the economy. If lawmakers fail to help our citizens improve their families’ lot in life, they risk erasing the remaining shreds of trust voters place in them.
What are a few simple, nonpartisan healthcare policies that Congress could accomplish to get people better and cheaper access to healthcare?
One lesson learned from the COVID-19 pandemic is that doctors need to be able to provide some care remotely, taking advantage of video communications to help patients who cannot or should not show up in crowded hospitals and doctors’ offices. Some of these patients will continue to benefit from telehealth after the pandemic subsides. It will save rural families long trips to their healthcare provider and help struggling, working families save valuable time on visits to a healthcare facility.
Last spring, 18 states and the District of Columbia implemented some sort of emergency policy to expand access to telemedicine, and 23 states along with D.C. made it easier for doctors to provide remote care from outside the state. An announcement by then-Vice President Mike Pence that the Department of Health and Human Services would allow all doctors to practice telehealth across state lines caused confusion and raised questions about federal authority, but the underlying idea was a step in the right direction. Rather than waiting on the vice president and the federal bureaucracy to act, Congress could – and should – take the initiative on this issue. Legislators should look at best practices and additional needs that remote healthcare providers have identified. Then, they should do everything in their power to remove regulatory burdens from telemedicine and make it as accessible as possible. By doing this, lawmakers would improve many people’s lives and demonstrate that they’re putting their constituents first, even in divisive and uncertain times.
Another area where Congress outsourced its job to the executive branch is drug price reform – and in this case, the result may cause actual damage, not just confusion. In September, President Donald Trump signed an executive order imposing the “most favored nations” drug price control scheme, stating that Medicare will not pay any more for medications than they cost in other developed countries. While a court later enjoined it, President Joe Biden also supports price controls. This sounds good in theory, given that the United States spends twice the average among OECD nations on prescription medications. It might also please voters who are angry at unscrupulous pharmaceutical companies. However, there is good reason to expect that this policy will do more harm than good.
Supporters of price controls often point out other countries where drug prices are lower. In reality, America’s free-market system enables other countries to get away with price controls in the first place. Those countries effectively transfer the costs of research, development, and testing new drugs to the United States – something that is not good for us or them in the long run. The health research society ISPOR reports that price controls slow down the development of new drugs by removing the profit incentive for drug developers. Additionally, the American Consumer Institute reports that patients in price-controlling countries can only access about half of the medications that Americans can. Losing our advantages in innovation and access would be doing a disservice to patients in our country.
Instead of waiting to see if price controls will work, Congress should tackle the real cause of high drug prices: excessive Food and Drug Administration regulations. A recent report by the President’s Council of Economic Advisors outlined several potential solutions. Legislators should take care to avoid compromising the safety of the testing process – but the FDA’s requirements add an average of 16 months to the years of clinical trials that new medications already undergo. Congress needs to identify ways to streamline this process.
That’s not to say that the FDA has done nothing to address the problem. The agency approved an unprecedented number of generic drugs and made more drugs available over the counter under the Trump administration. This is a great sign. The FDA has reported that having just two generic drugs compete against one another reduces prices by more than half, and having six competitors leads to a massive 95% drop in prices. Congress should see what it can do on its end to expand access to medications even further.
Ultimately, the biggest healthcare fight in Congress will concern the Affordable Care Act and the private insurance industry. But instead of expanding costly government programs, lawmakers could help empower a care option that allows people to bypass private insurers entirely. Direct primary care is not insurance; it’s a system where a patient pays a doctor a fixed monthly fee for a defined set of services.
DPC has enormous potential: A study by the Society of Actuaries found that DPC patients schedule appointments quicker, spend less time in the waiting room, and have more face-to-face time with their doctors than non-DPC patients. Best of all, these improvements did not increase the burden on our healthcare system. The study showed that DPC patients went to the emergency room 40% less often and used 12% less care overall. Regrettably, an Internal Revenue Service rule intended to help DPC users deduct their fees as medical care ended up treating DPC as insurance – which could lead to the same red-tape issues that plague the health insurance industry. Lawmakers should rectify this and do all they can to protect DPC as an affordable, innovative alternative to traditional insurance.
In the next four years, there will be plenty of bitter fights and partisan stand-offs in Congress, especially over healthcare. But before they take on Obamacare, the insurance industry, and other intractable issues, our legislators can do a few simple things that demonstrably improve their constituents’ lives – and convince the American people that Congress is still responsive to their needs.