Opinion

Health Equity and Innovation Are at Risk for All of Us

The rapid development of COVID-19 vaccines illustrates what’s possible when federal policy fosters innovation with a real public-private partnership, especially for the health challenges facing America’s more than 54 million older adults. Yet, a number of drug-pricing policy proposals now jeopardize this very model, threatening to limit access to prescription drugs, compromise health equity and slow progress on urgently needed new treatments for age-related chronic conditions.

Rather than build on the lessons of COVID-19, Washington seems to be trying to rewrite them — and our aging population can ill afford the unintended consequences. If we are worried about the fiscal sustainability of Medicare, let’s be honest about the problem: a program created nearly 60 years ago when we had neither a fraction of the elderly we have today nor the medicines, therapies, treatments, diagnostics and digital health now available. Demand is simply outpacing the ability of Medicare to cope. Pretending that reducing drug prices is the answer is nothing less than public policy malpractice.

Instead, finding new solutions for healthy aging is vitally important as we enter an era defined by longevity — when most health needs arise — and by a society with more old than young. Paying for and investing in innovation, including biomedical miracles, is the only way to mitigate the fast-growing health and economic toll of complex, chronic conditions of aging.

Currently, more than 80 percent of Medicare beneficiaries are managing at least one chronic condition, such as Alzheimer’s disease, heart failure, osteoporosis and diseases that impair vision. Additionally, there are a number of seniors still managing HIV who depend on effective and innovative treatments to manage their health. Current proposals would have an adverse effect on future innovations in HIV that are critical for disease management and our efforts to end the HIV epidemic. Health policy must stimulate innovation to meet this need while improving healthcare equity and addressing access challenges.

But what’s on the table just doesn’t work. Congress is currently considering a number of proposals that would give the government unprecedented power to negotiate the prices of certain prescription drugs. But a majority of the seniors who actually rely on the Medicare Part D prescription drug program have said they are concerned that these proposals could limit their ability to choose and access the medications they need to manage chronic diseases.

Price-setting proposals would also undercut new innovations to better control and prevent these diseases, reduce long-term costs and enable healthier aging. Even in a limited form, these proposals could remove companies’ incentive to invest in continued research and development efforts on behalf of patients. The Congressional Budget Office estimates that pricing reforms — with drug negotiation elements similar to H.R. 3 — would lead to fewer new drugs, slowing innovation when we need it most.

There’s a better way, and the innovation experiences of COVID-19 offer a clear case in point. Instead of rushing ahead with misguided policies that could harm those they intend to protect, lawmakers should support solutions that will foster a hospitable and dynamic environment for innovation in biomedical research. This is especially critical as our country and communities confront the difficult health challenges that come with modern longevity and population aging. The current proposals would stifle the innovative solutions that could serve to bend the otherwise unsustainable rise in health costs — not the drugs, but hospital stays, doctor visits and other health costs, which are themselves mitigated by biomedical innovation.

In addition, Congress should support health policies that directly address socioeconomic barriers to care, improve health equity and ensure treatment access for patients of all ages and backgrounds. Capping Medicare Part D annual out-of-pocket costs at $2,000 is interesting. But it fails to do what is advertised when combined with negotiation tactics that disregard the time, resources and expenses that go into creating new and more effective treatments that will help patients, caregivers and families across the country.

The COVID-19 pandemic illustrated just how quickly the pharmaceutical industry can develop incredibly effective therapeutics and vaccines, as well as other innovation support in areas such as digital health. But we need supportive public policies, which can then become the basis to apply the equity lens, so these miracle solutions are scaled across all societies. Rather than flipping our entire system for health innovation on its head as we emerge from the pandemic, federal policymakers should strengthen the system that continues to bring life-saving cures to all Americans and address existing health disparities. Health equity and ongoing biomedical innovation are profoundly dependent on each other and must be treated as such.

Together, we can create a system that is both more innovative and more patient-centered, accessible and equitable to support healthy aging. And while doing this, we might even find ways to enable Medicare’s 21st-century sustainability rather than the certainty that current proposals will, paradoxically, lead to its unraveling.

 

Michael W. Hodin, Ph.D., is chief executive officer of the Global Coalition on Aging; a fellow at Harris Manchester College, Oxford University; and managing partner, High Lantern Group. 

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