On February 8, Bernie Sanders led a group of Senators in his latest crusade against pharmaceuticals and the cost of drugs in the United States. Even the name of the committee—Health, Education, Labor, and Pensions, whose acronym is “H.E.L.P.”—dripped with irony. The subliminal message was clear—Sanders and his colleagues were there to “help” the American people by addressing the high cost of pharmaceuticals in the U.S. and shed light on the drivers of cost. Predictably and unfortunately, the hearing did neither. What it did do was provide a platform for Sanders to berate executives from three of the largest global industry leaders and attempt to shame them and their companies publicly.
The committee’s core message boiled down to several key points: drug prices in the U.S. are too high, especially when compared to other countries; too often people can’t afford to take the medicines they’ve been prescribed; and it’s all pharma’s fault. This core belief—that all the issues in the U.S. related to the cost of drugs rest at pharma’s feet—was the backdrop of the entire hearing. The belief that pharma could fix the mess (since it was pharma’s fault) was reflected in the question Sanders repeated several times: “So, CEOs, what are you going to do about it?”
In his prepared remarks for the hearing, Sanders stated that one of his top priorities “is to substantially reduce the price of prescription drugs in America.” The priority is laudable and would likely be supported by most Americans who are aware of the price of drugs when they fill their prescriptions. But trying to blame pharma alone misses the mark. And suggesting that the industry is somehow responsible for life expectancy in the U.S. which has been known for years to be lower than many other developed nations, underscored the real agenda.
At one dramatic moment in the hearing, Sanders attempted to draw a causal connection between drug prices and life expectancy, implying that where drug prices are lower, life expectancy is higher. Having made the point that prices for certain drugs manufactured by J&J, Merck, and BMS are significantly lower in Japan, Canada, and other countries, Sanders went on to note, “the life expectancy in Japan is nine years longer than it is in the United States…. Life expectancy in Canada is six years longer than in the United States. Life expectancy in Portugal is six years longer. Life expectancy in the UK is four years longer.” While life expectancy is longer in these other countries compared to the U.S., a correlation is not causation. All researchers know this, and Bernie Sanders and his staff likely do as well. To imply such a causal connection was either an irresponsible oversight or deliberately misleading.
Patients in the U.S. have significantly earlier access to innovative, life-saving medicines than patients in other countries. To the extent that access extends life, these medicines increase life expectancy in the U.S. For those patients who need medicines and cannot afford them, then lack of access will negatively impact their individual life expectancy. But access to medicines is only a part of the life expectancy equation.
A whole host of factors contribute to life expectancy—diet, exercise, behavioral health, lifestyle choices, to name a few. Researchers have known, for example, that Japanese people living in Japan have longer life expectancy than counterparts living in Hawaii who in turn have enjoyed longer life expectancy than those living in other parts of the U.S. Differences in life expectancy are about so much more than drug costs. For instance, the CDC reports that 1 in 4 Americans are not active enough to protect their health. And the U.S. would be worse off without the major healthcare innovations driven in no small part by the pharmaceutical industry. According to a Health Affairs study, U.S. life expectancy has increased 3.3 years since 1990, with pharmaceuticals accountable for 35% of improved life expectancy for all causes of death.
The most helpful thing that Sanders and his “H.E.L.P.” Committee could have done—but did not—is to take a broader, constructive approach to the healthcare ecosystem, evaluating how the pieces fit together, understanding how we got here over decades, and outlining what’s required to fix the massive issues we face. Congress and current/prior administrations have played a significant role in getting us here, and they have an important part to play in fixing the current state.
One answer, as I explained in a recent column, has been a failure to move from a broken fee-for-service system that has decoupled payment for services from quality outcomes and incented volume of procedures over prevention. And every healthcare stakeholder is complicit in allowing this broken model and perverse incentives to keep going.
The most salient part of the entire hearing came early on in Senator Cassidy’s opening remarks: “the problem is far greater and more complex than individual companies or even a set of companies within an ecosystem.” He continued, “We need to have a serious effort to navigate the network of perverse incentives throughout the health care system… taking a substantial look at insurance benefit design, price transparency, regulatory barriers, intellectual property barriers, the perverse effect government discount programs have upon prices charged to commercial patients, etc.” This understanding of the real ecosystem—and the many players who benefit from high prescription costs, which goes far beyond a few pharmaceutical CEOs—was refreshing, but the overt political agenda bulldozed right past him.
Until Senator Sanders and colleagues are willing to engage in real collaborative efforts to fix problems that they have enabled through legislation they’ve written and passed with predictable, if unintended, consequences, nothing will change. Pointing fingers at industry leaders is political theatre; it is not a serious effort to solve serious problems. Consumers and the country deserve more.
