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Here’s what good health care looks like: it emphasizes prevention, is accessible and affordable, and puts patients’ needs first.

Unfortunately, recently proposed health care reforms from Congress don’t look like that at all. Instead, they seem to be leaving patients behind. Lawmakers in Washington are turning to overly complex alterations of the market and restrictive models of care that do little to directly help patients now. To get a clearer picture, they need to start listening to patients.

They especially need to listen to those with chronic illnesses, who know all too well the damage that unexpected changes to treatment plans can cause.


Medicare remains the bedrock for quality health care treatment in the U.S. In California, where I live, roughly 4.5 million people rely on this program for care. While there are certainly areas in which Medicare can improve, beneficiaries give the program high marks for the access to care it provides. That’s what makes proposals to implement wholesale disruption to Medicare, potentially restricting access and undermining innovation, so troubling — especially when there are other reforms that more directly benefit patients without sacrificing Medicare’s strengths.

Take the proposal for international reference pricing. It would lower drug prices in the U.S. by linking them to the prices paid in 16 developed countries, including Germany, the United Kingdom, Canada, France, and Japan, and placing an arbitrary cap on U.S. drug prices. When you look at this proposal closely, it quickly falls apart. These countries, with vastly different health care systems, restrict patients’ access to medications or require them to try cheaper alternatives before being granted access to newer therapies.


That is unacceptable to people with chronic illnesses, many of whom live with multiple diagnoses and require treatment regimens tailored to their individual needs. If available treatments in Medicare become harder to access thanks to these foreign-based price caps, their health may suffer as a result.

The effect of drug pricing proposals in which the government sets prices will result in restricted access to medications for patients and doctors. Government price setting would have unaccountable bureaucrats dictate what treatments are available and which are not. As with international reference pricing, government price controls may create new, unnecessary barriers between patients and the quality care they have come to rely on within the Medicare program.

But we don’t have to choose between access and affordability. A simple way to control the cost of prescription medications, particularly for individuals living with chronic illnesses, is to place a cap on out-of-pocket spending in Medicare Part D. Doing so would directly alleviate individual cost burdens for medications without limiting options for treatment.

Medicare’s prescription drug benefit already includes ample negotiation between pharmaceutical companies, pharmacy benefit managers, and insurance plans. These negotiations produce substantial rebates or discounts for treatments. Unfortunately, many of these rebates never get to patients as they purchase medications, as intended. A beneficial and minimally disruptive approach to increase affordability for patients is to reform how these negotiated discounts get to patients. This simple change could go a long way toward reducing the costs of medications, without additional red tape or restrictions.

Understanding what good health care looks likes means we can recognize bad health care reforms when they are proposed. Patients calling for reform aren’t seeking more administrative red tape or arcane systems telling them which treatments are unavailable. They are simply calling for affordability to match the quality care they have received for years.

It’s time for lawmakers to start listening to patients.

Liz Helms is the president and CEO of the California Chronic Care Coalition.

  • As said by other commentators, author is a lobbyist in her own right. Everyone has vested interest and will do whatever is necessary to make sure the current apple cart is not disturbed. Mutually subsidized healthcare system is the biggest culprit and no one one wants to change. Politicians, PBMs and their supply chain partners plus drug manufacturers are to blame.

    We keep on blaming pharma companies but have not touched and or talked about the BIG GORILLA in the room which is PBMs and their accomplices. Drug manufacturers are pressured to assure profits of the PBMs and accomplices.

    In our legally corrupt legislative system politicians sleep in the same bed with pharma companies and PBMs and accomplices. They scratch each other’s back. They all know that patients will die sooner or later so they love to talk but cannot walk the talk. I don’t expect anything witch change. FDA is part of the problem as it has systems in place that make competition a challenge.

    Linked walk through what happens between a drug producer and patient.

    PBMs and FDA need to be harnessed and re-invented. Since FDA is largely funded by pharma companies through fees, they will not change as they will be trimming their kingdom. NONDESTRUCTIVE CREATION is needed in PBMs and FDA. As soon as that happens drug prices will drop and quality will improve. I hope that will impact rest of the healthcare system.

    Apologies of the long post but until we look form outside the box, nothingnesses much will happen. Cheers.

  • Despite leading the world in healthcare spending, the U.S. lags other OECD countries in many major measures of health, including life expectancy, the incidence of diabetes, heart disease, respiratory disease and infant mortality.
    If every major country can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita, why can’t the U.S. do the same?

    • I so agree, it’s amazing that self interested politicians and corporate lobbyist will forgo the health our Americans for corporate profits and scoff at anyone that supports a National program calling it socialism. It’s an American rip off. It’s time to have an option to private insurers, an competitor like Medicare and Medicare supplements for everyone, oh an include price transparency for everything.

  • Capping Medicare Part D shifts the cost of supplying expensive medications to the federal government without impacting Pharma profits. Pharma companies have a monopoly on pricing and follow an extractive model, along with pharmacy benefit managers and insurance companies, of taking as much money as the market will bear from patients and governments to keep profits high. Transparent look at research costs, cost of goods and value to patients is what should drive pricing. Prices should not be set in terms of what other therapies charge, as all pricing for drugs is based on this extractive model. There is no “free market” in the pharmaceutical industry.

    • First of all, if I understand correctly, there is, for all intents and purposes, already a cap on out of pocket spending with Medicare Part D. Which has had no effect on the cost of medications.

      Second, the prices are apparently set by a “what the market will bear” model, where competing drugs are priced almost exactly the same. Where is anti-trust when you need it? Rather than a cost-plus model followed by most industries.

      All of this tends to leave the pricing so opaque that I have to just pray during the rare occasions when I use an expensive drug. Many of the generics are priced at $10 for 90 days, making the comparison even more stark.

  • The very clear and constructive view presented by this author underscores the chaotic mess being caused by lawmakers, to the detriment of care access and patients’ needs. The named other countries indeed have vastly better price systems, as these are funded by loads of taxpayers’ moneys. The US does not tax the same way, and this different beast should first adapt its HC and taxation systems to become fair for everyone.

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