BY KIM BELLARD

On one of the Sunday morning news programs Governors Spence Cox (UT) and Jared Polis (CO) promoted the National Governors Association initiative Disagree Better. The initiative urges that we practice more civility in our increasingly civilized political discourse. It’s hard to argue the point (although one can question why NGA thinks two almost indistinguishable, middle-aged white men should be the faces of the effort), but I found myself thinking, hmm, we really need to do that in healthcare too.  

No one seems happy with the U.S. healthcare system, and no one seems to have any real ideas about how to change that, so we spend a lot of time pointing fingers and deciding that certain parties are the “enemy.”  That might create convenient scapegoats and make good headlines, but it doesn’t do much to solve the very real problems that our healthcare system has. We need to figure out how to disagree better.

I’ll go through three cases in point:

Health Insurers versus Providers of Care

On one side, there are the health care professionals, institutions, organizations that are involved in delivering care to patients, and on the other side there are health insurers that pay them.  Both sides think that the other side is, essentially, trying to cheat them.

For example, prior authorizations have long been a source of complaint, with new reports coming out about its overuse in Medicaid, Medicare Advantage, and commercial insurance.  Claim denials seem equally as arbitrary and excessive.  Health insurers argue that such efforts are necessary to counter constantly rising costs and well documented, widespread unnecessary care. 

Both sides think the other is making too much money and has become too concentrated. 

This is a pointless battle, one that confuses the symptoms for the problem.  The problem is that we know too little about what care is appropriate for which patients in what settings by which professionals, much less about who in the system are incompetent or overly avaricious. Solving that issue is perhaps the most important thing that everyone in the healthcare system should be focused on.  If we knew those things, irritants like prior authorizations or claim denials would cease to be issues, not to mention that patients would get better care.  

Disagreeing better would mean stop blaming the other side and start addressing the underlying problem.

Prescription Drug Prices

It’s no secret that the U.S. has long had the world’s highest prices for prescription drugs.  Pharmaceutical companies claimed they needed those prices to fund innovation, and to subsidize those discounted prices in the rest of the world. They’ve played tricks like extending patient protections, even on drugs like insulin that are decades old. Their tricks led to the Lown Institute to create the Shkreli Awards, highlighting the year’s “most egregious examples of profiteering and dysfunction in health care,” naming the award after the disgraced pharmaceutical executive.  

In 2022, Congress finally got around to allowing Medicare to negotiate price prices – for a small number of drugs – and the drug companies are responding as one might expect, “throwing the kitchen sink” in their efforts to slow or negate such negotiations.  It would stifle innovation, and take away their Constitutional rights, they argue. 

We were all (well, most of us) happy when drug companies quickly developed COVID vaccines, but it took $32b of federal spending to accomplish that, and, speaking of greed, we’re seeing problematic shortages of critical drugs because generic drugs aren’t as profitable for the drug companies.

The reality is that Medicare is pretty much the only major health insurance program (public or private) that hasn’t negotiated prices, and it’s shortsighted to expect that could be allowed to persist indefinitely.  Meanwhile, we’re seeing drugs whose prices are in the millions of dollars range, and less than half of new drugs approved appear to be of substantial therapeutic value over existing treatments.  This is a state of affairs that cannot persist.

Some drug companies bit the bullet when Medicare capped insulin prices, applying the $35 out-of-pocket limit more broadly, and the pharmaceutical industry need to be similarly thinking more about their public image – and the public good – when it comes to the forthcoming Medicare negotiations.

Disagreeing better would mean acknowledging that there’s “reasonable rate of return” pricing and there’s price gouging, so let’s find that line. 

Abortion

This is perhaps the best example of disagreeing badly, and deserves an entire article devoted to it, so I’ll have to try to make my points succinctly.  Look, I get that, for some people, the belief that life begins at conception is a moral or religious one that cannot be argued.  It’s like the 19th century abolitionists believing slavery was wrong; thank goodness now for their stubbornness then against the tides of society at that time.  

But pro-life advocates need to recognize that not all religions or moral frameworks agree with theirs, and in America one religion is not supposed to dictate to others. It’s also hard to understand a religious or moral point-of-view that values the life of an unborn child above life of the mother, as some bans essentially do.  

It should raise eyebrows that one consequence of abortion bans has been an increase in infant deaths. If we care so much about life, then our maternal and infant mortality rates would be much better.  We’d also do much better about postpartum care, including ensuring Medicaid and other care, and would ensure adoption and foster care are viable alternatives.  And we sure as hell would not be complacent about 11 million children living in poverty. It’s hard to see what religious or moral principles wouldn’t have as much fervor about these problems with as with abortion.

Disagreeing better would mean both understanding that trying to impose our beliefs on others should also include acknowledging their views, and recognizing that preventing abortions creates consequences that moral people cannot ignore.  

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Politics impacts all of our lives, but often does so at a distance that many of us don’t easily recognize.  Health care, though, impacts most of us directly and visibly, both in our health and in our pocketbook.  Cynical as I can be, I still believe that most people in healthcare are trying to do the right thing, although sometimes they get confused about what that may be.

We’ve got to stop trying to find enemies in healthcare and start making allies, so that we can solve its problems.  Disagreeing better is a way to start.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.