Why Bernie Sanders says his ‘Medicare for All’ dream must wait
After railing at the injustices of U.S. health care for decades, Sen. Bernie Sanders in January became the new chairman of the Senate Health, Education, Labor & Pensions Committee. The job gives the health care industry’s biggest Washington nemesis an unprecedented opportunity to shape health care reform in Congress. But the sort of radical changes he seeks could prove elusive. Even Sanders concedes there are limits to the powers of his position.
President Joe Biden’s State of the Union address Tuesday night showed how much of Sanders’ platform has moved into the mainstream of the Democratic Party, with Biden at times sounding like his former Democratic primary foe, lashing out at Big Pharma and its “record profits.” Biden bragged about measures taken to lower drug prices and halt surprise bills during his term thus far, and he urged Congress to pass a federal expansion of Medicaid.
Still, the radical changes Sanders seeks could prove elusive. During an interview with KHN at his Senate office recently, the independent from Vermont spoke about the prospects for lowering drug prices, expanding access to primary care, and his ultimate goal of “Medicare for All.”
The interview has been edited for length and clarity.
Q What do you hope to achieve as chair of the HELP Committee — in terms of legislation, but also messaging and investigations?
A What I ultimately would like to accomplish is not going to happen right now. We have Republicans controlling the House. And many of the views that I hold, including Medicare for All — I think if we had a vote tomorrow, we’d get 15 to 20 votes in the Senate and would not win in the House. I realize that. But I happen to believe our current health care system is dysfunctional.
We spend twice as much per capita on health care as other countries and 85 million people have no insurance or are underinsured. It is a dysfunctional system that to my mind needs to be fundamentally changed to a Medicare for All system — but we ain’t gonna get it.
Q What can you actually accomplish?
A (From) a poll a couple of months ago just among Republicans. Top concern? High cost of prescription drugs. We’re long overdue to take on, in a very bold way, the greed and outrageous behavior of the pharmaceutical industry.
Q There are so many parts of the system that are messed up — patents, 340B, pharmacy benefit managers, insurance issues with formularies …
A Right, there are a million parts to this problem.
Q So short of a complete overhaul, what are the parts that you think you can change?
A Every year the U.S. government through (the National Institutes of Health) spends tens of billions of dollars on research. The Moderna vaccine was co-developed between Moderna and NIH and received billions of dollars in assistance, guaranteed sales, and you know what’s happened in the last couple of years. The CEO of Moderna is now worth $6 billion. All their top executives are worth billions. And now they are threatening to quadruple prices. This is a company that was highly supported by taxpayers of this country. And that’s one example of many.
What is the responsibility of a drug company that receives very significant support — financial support, intellectual support for research and development — to the consumers of this country? Right now, it is zero. “Thank you very much for your support. I will charge you any price I choose.” We have to end that.
That’s the starting point.
Q But what’s the mechanism? “March-in” rights, whereby the government could force a company to share its license for a drug that was developed with federal investment, allowing others to produce it?
A That is one approach. Threatened by people in George W. Bush’s administration, by the way. March-in is one option.
Reasonable pricing is another area. I have made two trips to Canada: once as a congressman from Vermont, took a bunch of working-class women across the border to buy a breast cancer drug; once as a presidential candidate, took people from the Midwest, and we bought insulin. The price was onetenth of the U.S. cost in both cases.
Another area is primary health care. I have worked hard with other members through the Affordable Care Act and American Rescue Plan (Act) to significantly expand community health centers. FQHCs (federally qualified health centers) provide primary care, dental care, mental health counseling, and low-cost prescription drugs. About one-third of [people in Vermont] get primary care through community health centers.