US Healthcare Reform: The ISPOR Debate
Much like the Pixies, who spent the last few days playing a series of concerts on their home turf here in Boston, ISPOR has kicked off its 22nd annual international meeting this morning in the birthplace of decision analysis, one of the founding principles on which ISPOR is based. Massachusetts is of course also home to some of the most important and wide-ranging state-level healthcare reform initiatives in the US, which is very apt given that the plenary session kicked off with a high-level discussion on the state of the US healthcare system in light of the current administration's repeal and replace agenda.
While the plenary panel included representatives from both sides of the political aisle, there appeared to be significant consensus over the fact that many are worried, and frustrated, over the direction that US healthcare reform is taking. Most notably, there were concerns that the US may now stall at its current rate of roughly 9% of the population being uninsured. Panelists also expressed worries that the US will lose ground on making the system more efficient, and that current discourse is primarily directed at undermining ACA at whatever cost.
There was significant discussion on a variety of "facts" that often get lost in this discourse (and one can't help but wonder what is meant by a fact these days). Perhaps most prominently, the discussion turned to whether the ACA was in the "death spiral" that is often highlighted in the political debate - it was noted that while premiums are indeed increasing, in fact premiums grew significantly faster before ACA than after. Also, while insurers were indeed losing money in 2015, and there is still limited competition in some exchanges, it was generally recognised that the market had stabilised in 2016 - and the main reason it is currently in turmoil is because of the uncertainty brought on by the various proposals set out by the current administration.
The panel then turned to the perhaps surprising idea that the current chaos undermining the future direction of US healthcare may lead to greater acceptance for, and momentum towards, a single-payer system based on Medicaid. The general conclusion was that this was outlandish, but highlights the depth of the uncertainty of how the system will evolve - it could almost go in any direction at this point. It was also highlighted that in the absence of any bipartisan support for the Republican agenda, it was entirely clear that any future Democrat majority would seek to undo whatever the Republicans are able to achieve.
On the issue of pharmaceutical pricing, the panel generally felt that the status quo, or something close to it, is likely to remain, despite President Trump's strong pronouncements that the industry is "getting away with murder". One panellist highlighted that the current system is working, citing the example that new entrants to the HCV space made the market competitive and ensured that high profile, high cost treatments such as Sovaldi and Harvoni cut their prices to levels that are seen in Europe.
Ultimately, this was an unusually passionate panel debate, as befits an unusually volatile political environment, and nobody had a clear answer on what is likely to happen next. And the debate will likely continue to evolve in the next few days here in Boston....
Gustav Ando is the Head of the Life sciences Practice at IHS Markit.
Posted 23 May 2017
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