Gottlieb warns Medicare-for-all could hit political fast-track after election
May 12, 2019 | By Stephenie Overman | firstname.lastname@example.org
Debate on the presidential campaign trail about a national health care program could become a political reality if Democrats win the White House and the Senate, former Food and Drug Administration Commissioner Scott Gottlieb said at a May 10 National Press Club Headliners luncheon.
Candidates advancing so-called "Medicare for all," a proposed single national health insurance program for all U.S. residents, could implement it with only a slim Senate majority, he said.
Gottlieb said he doesn't support the Medicare for all approach but he warned it could be put on a political fast-track.
“The two key elements of Medicare for all could be achieved through budget reconciliation — expanding benefits to include younger people, and eliminating private insurance coverage by taxing employer-sponsored insurance,” Gottlieb said.
Budget reconciliation is a legislative vehicle that circumvents a Senate filibuster and lets a bill pass with 51 votes.
“If a Democratic candidate wins the White House in 2020, it’s conceivable that the new president could also seize control of the Senate," he said. "Democrats already used budget reconciliation to pass much of Obamacare, and Republicans used it for their repeal.”
The Congressional Budget Office would estimate that much of the cost of employer-sponsored coverage would be passed through to employees in the form of higher wages. These earnings would then be subject to FICA and income tax. That increased revenue could offset a lot of the cost of the Medicare expansion, according to Gottlieb.
“Expanding covered services in legislation may be hard under reconciliation. But lowering the eligibility age or even eliminating cost sharing might be possible,” Gottlieb said.
Gottlieb asserted this scenario would be a setback for the U.S. health care system.
“I’m not advocating this approach," he said. "I think it could squelch innovation and medical progress.”
The private market “has shown a much better ability to incorporate beneficial new innovations than government insurance programs like Medicare and Medicaid. It’s been much more willing to embrace sweeping advances in medical care.”
Gottlieb was sworn in as the 23rd FDA commissioner in May 2017 and left the position April 5. He is now a resident fellow at the American Enterprise Institute.
During his FDA tenure, Gottlieb focused on lowering drug prices, developing tobacco and e-cigarette regulation, addressing the opioid crisis, increasing the number of approved generic drugs, and boosting competition to make pharmaceuticals more accessible.
With prescription drugs, “it isn’t just a question of price. It’s a question of access. Access can be forestalled, in Medicaid and skinny health plans. People can be locked out,” he said. “A treatment that can deliver a cure takes on a special public health value. People’s destiny should not depend on whether they can pay for a cure.”
In the case of the high price of insulin, currently a hot topic, Gottlieb said that “net prices have gone down. The list price gets pushed up because they want to have big rebates….There has been innovation in this market. Each generation [of insulin] gets slightly better.”
There continue to be cheap insulins on the market that “do the basic job but they’re not as good. Ultimately you don’t want people to have to use a product that’s not as good. If there is not access, it exacerbates poverty” because of the complications of improperly controlled diabetes, he added.
Under Gottlieb’s leadership, the FDA launched investigations into the e-cigarette market and banned sales of some vaping products that critics said appeal to young users.
But Gottlieb said he does see some value to alternative products that allow addicted adult smokers to get access to nicotine without all the risks associated with using combustible tobacco products.
“I believe in a continuum of risk. You want to move people down the continuum of risk. A product that is less harmful, but not safe in its own right – there is a place for that,” he said.