Sen. Debbie Stabenow (D-Mich.) grew up around healthcare in the shadow of her mom—the nursing director of a rural community hospital in Michigan.
Stabenow’s first real job was cleaning test tubes in a lab. As a Michigan State University graduate student, she supported a group trying to save the Ingham County public nursing home, a safety-net facility for low-income seniors. That experience fueled her political ambitions.
Healthcare is undeniably personal, Stabenow said during her opening keynote at Modern Healthcare’s Leadership Symposium. But one could hardly tell from the political rhetoric, she said. “The U.S. healthcare system has become a political lightning rod, which doesn’t help you get support or families get the support they need,” she added.
Efforts to repeal or undercut the Affordable Care Act have served as a distraction, Stabenow said. She has tried to refocus the conversation by advocating for boosting payments for federally certified community behavioral health clinics and integrated mental healthcare, extending the Children’s Health Insurance Program, full federal financing for newly expanded Medicaid states, and reining in drug spending and related out-of-pocket costs.
Rather than implementing a Medicare for All system, people ages 50 to 65 should be allowed to buy into Medicare, which could stop people from putting off care, Stabenow said. This cued up the ensuing panel discussion.
The Medicare for All math doesn’t add up since it doesn’t reimburse the full cost of care, said Rick Pollack, CEO of the American Hospital Association. “At some point, that becomes an access problem where people can’t care for Medicare beneficiaries,” he said.
Chip Kahn, CEO of the Federation of American Hospitals, argued that the ACA was a version of universal coverage that hasn’t been fully realized. The law shouldn’t be thrown out altogether, he said. “Why do we want to turn everything upside down when we know we then open ourselves up to a whole new set of problems?” Kahn asked.
It’s unlikely major proposals will be passed in the current political climate other than drug price regulation and surprise billing reform, panelists said. But policy reform will only go so far, Banner Health CEO Peter Fine said. “I don’t know how you manage cost in healthcare until you manage usage.”
As for drug prices, drugmakers have successfully diverted the attention to pharmacy benefit managers and the rebate model. Repealing that would be “catastrophic for the Medicare program,” said Anthony Barrueta, senior vice president of government relations for Kaiser Health Foundation Health Plan. If drugmakers win the debate by vilifying PBMs, it won’t be long before price controls come into play, he argued. Countries like Australia and New Zealand are essentially willing to say no to manufacturers of exorbitantly priced drugs. “The question is whether we can build that kind of dynamic into the American system … or is it impossible because of our culture because people are never willing to say no?” Barrueta said.
Healthcare’s problem is related to behavior, Fine said. Everyone wants what they want instantaneously.
“You can change a business model, but changing a culture is way more difficult,” he said.