Physicians Urge Administration to Make ‘Big and Bold’ Changes in Right Direction


Newly installed Secretary of Health and Human Services Alex Azar says that President Trump wants “big and bold” health care changes. The Association of American Physicians and Surgeons (AAPS) agrees that such changes are long overdue, but urges the Administration to base them on a correct diagnosis.

Azar’s four areas of concern are lowering drug prices, making private insurance more affordable and accessible, restructuring payments so they’re based on care quality and not quantity, and addressing the opioid epidemic.

AAPS notes that drug prices are often outrageous, but cautions against imposing more price controls, which may euphemistically be called “negotiation.” HHS should instead review FDA regulations that have raised the cost of bringing a new drug to market to $2.6 billion, or that prevent generic drugs from reaching the market. Additionally, there’s the huge burden of “rebates” and “sharebacks”—a.k.a. kickbacks—collected by pharmacy benefits managers (PBMs) under the cover of “safe harbors” in the Anti-Kickback Statute. The HHS Inspector General’s office has not exerted its oversight authority in years. Many advocate repeal of the relevant statute provisions and regulations exploited by PBMs.

Private insurance cannot be made affordable and accessible, AAPS states, as long as ObamaCare regulations are in place. These drive premiums out of the reach of most middle-class Americans who don’t qualify for enormous taxpayer subsidies. If Congress refuses to repeal these requirements, HHS must provide as much regulatory relief as possible, for example by allowing short-term plans to be guaranteed renewable and by seeking ways for states like Idaho to free their citizens from over-regulation.

The problem with today’s payment policy is that expenditures are based on convoluted price controls that reward system-gaming by powerful stakeholders instead of value to patients, AAPS points out. “Quality” cannot even be defined, and paying by bureaucratic metrics instead of “quantity” means restricting services that patients need or desire. The new MIPS (Merit-based Incentive Payment System) discourages care of sick people and encourages box-checking.

The opioid epidemic began around 2013 with the flow of unaccompanied alien “children” (UACs) into the U.S. Ever-tighter rules on physician prescribing make it harder for patients to get pain relief. Yet deaths from overdoses soar because of illegal heroin and fentanyl from transnational drug cartels exploiting our porous border.

The answers are honest price signals, free-market competition, legalizing true insurance, putting patients in control of their money, and securing our border—not more of the same failed policies, states AAPS.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in virtually all specialties and every state. Founded in 1943, AAPS has the motto “omnia pro aegroto,” which means “all for the patient.”

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