My colleague Dr. Robert Graboyes encourages us to instead think about how to produce better health (not health insurance—not even health care) for more people at a lower cost, year after year. This requires allowing and fostering the kind of revolutionary innovation in the health care industry that we’ve seen in other fields, like information technology. It requires allowing consumers to choose treatments, even high-risk ones. But it also requires innovation in the provision and payment of health care.
For instance, advancements in gene therapy and personalized treatments could one day offer a cure for cancer or disorders currently considered incurable, sometimes with only a single injection. In 2017, the Food and Drug Administration approved its first gene therapy treatment, Kymriah, for acute lymphoblastic leukemia. The FDA expects 10 to 20 cell and gene therapy approvals annually by 2025.
American consumers and policymakers are increasingly concerned about the high cost of prescription drugs. According to the Kaiser Family Foundation, one in four people taking prescription drugs report difficulty affording their medication. There is bipartisan support for policies that could help lower drug prices and their burden on consumers. Legislation has been introduced and regulatory actions have been advanced to promote competition among drug manufacturers and slow the growth of prices.
The single-payer health insurance proposal known widely as Medicare for All (M4A) cannot be enacted without first answering certain questions. Foremost among these is whether the public would support shifting more than $32 trillion in M4A’s first 10 years from private health spending, over which consumers retain some discretion, to federal health spending, over which consumers do not. A related open question is whether the federal government can adequately finance this amount of spending without triggering significant adverse economic effects. Other unanswered questions include M4A’s effects on health providers, the prescription drug market, and private health insurance. M4A would add further to national health cost growth unless provider reimbursements are cut more sharply than lawmakers have been willing to do historically. Yet the consequences of enacting such payment cuts simultaneously with a substantial increase in health service demand are unpredictable.
One aspect of CMS’ price transparency initiative has received a great deal of attention recently. Our updated guidelines now require hospitals to post a list of their current “standard charges” on the internet in a machine-readable format — meaning the data can not only be read electronically but can also be imported or read into other databases. Previously, CMS required hospitals to make their standard charges available in response to an inquiry, but too often this meant making the information available only in print or a PDF that couldn’t be aggregated with other data and that wasn’t broadly available.