CHICAGO - As the nation inches closer to the 2020 presidential election, issues with the U.S. health care system are moving into the spotlight.
At stake: the future of the Affordable Care Act, also known as Obamacare; proposals to expand "Medicare for All"; and ideas to target high drug prices. They're all topics sure to spark fierce debate in coming months.
The Tribune sat down with Seema Verma, head of the federal Centers for Medicare & Medicaid Services and an appointee of President Donald Trump, to discuss those issues Monday. Verma was in Chicago to speak at the annual meeting of the American Medical Association.
Verma opposes Medicare for All, the idea of expanding Medicare to cover all Americans, and the administration said earlier this year it supports a Texas judge's ruling that Obamacare is unconstitutional. The administration also has taken a number of somewhat controversial steps toward attacking drug prices.
This interview has been edited for length and clarity.
Q: The doctors who support Medicare for All say it would allow doctors and hospitals to spend less money on administration because they wouldn't be dealing with multiple insurance companies. What are your thoughts on that argument?
A: One of the things I hear a lot is we should go to Medicare for All because of the lower administrative costs. The reality is we're not spending enough on administration within Medicare. There's a lot of bureaucracy that goes on with the Medicare program in terms of access to technology, protecting taxpayers against fraud and abuse and it's because we haven't made those investments in administering the program like you would see in the private sector.
The main issue with Medicare for All and having the government take over the entire program, is that we're not going to see savings. It's actually going to cost more, which means taxpayers are going to pay more, and when they're paying more, that's going to lead to rationing of care and problems with access to care.
Q: According to some surveys, most Americans support a government-run health insurance system. How do you respond to that kind of public opinion?
A: When you dig a little bit deeper into those surveys and people understand that it means that they're going to be stripped of their private coverage, that they're not going to be able to make choices, that innovation is going to be impacted, that they may have longer wait times - when you put all those pieces together, Americans are not supportive of that.
Q: For a lot of people, the bottom line is that seniors look forward to being on Medicare. People are eager to turn 65 so they can be on Medicare and no longer have to have private insurance. If seniors like it so much, why can't it work for everyone?
A: We need to have a solution that provides affordable health care coverage and that all Americans have access to that. But the Medicare program was uniquely designed for seniors and those seniors have paid into the program their entire lives, and we need to make sure that program is protected and preserved for those beneficiaries, and address access to affordable coverage for other Americans.
Q: When it comes to the Affordable Care Act, a lot of people are unhappy with the way prices for health insurance have increased. But they're happy about the rules barring discrimination based on preexisting conditions and the disappearance of caps on how much insurers will pay for coverage. There's a feeling among some people that regulation is needed, that competition among insurers alone is not going to result in the best outcomes for people.
A: This administration supports protections for people with preexisting conditions and we understand there is some regulation that works well. I think the issue is government overreach and going too far. While the (Affordable Care Act) has provided protection that we support, it has also driven up health insurance premiums.
Q: Should Americans continue to buy insurance through the Affordable Care Act exchange when the Trump administration has made it clear that it wants the law to disappear?
A: The law is not working. What we want to do is provide more affordable options for individuals.
Q: Would you encourage people to still buy on the exchange at this point?
A: For people that are eligible, we want to make sure they have as many options as possible, so if that works for them, then that's certainly something that they might want to pursue.
Q: When it comes to drug prices, insurers, pharmacy benefit managers and pharmaceutical companies all point the finger at one another. Does the Trump administration believe in primarily directing its efforts toward the drug companies?
A: As we are talking about efforts to make health care more affordable, one of the things we're looking at is drug pricing because that is one of the fastest growing areas of health care spending in the United States. That being said, I do think there are fingers to be pointed in a lot of different directions. Some of the concerns we have with pharmaceutical companies is that Americans are not getting the best deals.
We also have a lot of concerns with the rebates that are going on in terms of (pharmacy benefit managers) and the rebates that are kind of behind the scenes deals that don't result in seniors getting the best price possible. One of the things we recently did was require pharmaceutical companies to actually put the prices of their drugs on TV ads. We're tackling drug pricing from a lot of different angles.
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