Less than a month after Democrats — many of them running on “Medicare for All” — won back control of the House of Representatives in November, the top health policy aide to then-prospective House Speaker Nancy Pelosi met with Blue Cross Blue Shield executives and assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices, according to sources familiar with the meeting.
Pelosi adviser Wendell Primus detailed five objections to Medicare for All and said that Democrats would be allies to the insurance industry in the fight against single-payer health care. Primus pitched the insurers on supporting Democrats on efforts to shrink drug prices, specifically by backing a number of measures that the pharmaceutical lobby is opposing.
Primus, in a slide presentation obtained by The Intercept, criticized single payer on the basis of cost (“Monies are needed for other priorities”), opposition (“Stakeholders are against; Creates winners and losers”), and “implementation challenges.” We have recreated the slides for source protection purposes.
Democrats, Primus said, are united around the concept of universal coverage, but see strengthening the Affordable Care Act as the means to that end. He made his presentation to the Blue Cross executives on December 4. “We don’t discuss private meetings, if there was such a meeting,” said a BCBS spokesperson. Primus said that he did not discuss any kind of deal with the insurers. Henry Connelly, a spokesperson for Pelosi, said that the assessment of single payer was not related to any dealmaking with the industry. “We’re not going to barter lower prescription drug costs for inaction in the rest of the health care industry. The presentation was a broad look at the health care environment and some of House Democrats’ legislative priorities over the next two years in a period of GOP control of the Senate and White House,” Connelly said.
The debate over Medicare for All is playing out on a number of different levels, with no clear consensus over how the government-run, single-payer health plan ought to take shape. Presidential candidates are arguing over whose plan is stronger and gets to full Medicare for All faster, with a debate raging over whether private insurance should be banned outright or operate in addition to universal Medicare coverage.
In the House, even as the idea has picked up momentum with voters and members of the Democratic caucus, Democratic leadership has remained deeply skeptical. Pelosi’s consistent messaging, instead, has been around protecting the Affordable Care Act and lowering prescription drug prices.
“Speaker Pelosi has ensured that Medicare for All will have hearings in the House and tapped Congressman Brian Higgins to take the lead on Medicare buy-in legislation. For the first time, House committees will be seriously examining and tackling some of the questions and possible solutions raised by Medicare for All legislation,” said Connelly.
“The biggest obstacles facing Medicare for All right now are Mitch McConnell and Donald Trump,” he added. “But in the near term, there is a window for Democrats to press Trump to help pass aggressive legislation to negotiate down the skyrocketing price of prescription drugs.”
Primus concluded his presentation with a bullet point that summarized Pelosi’s mission on health care: “Lower your health care costs and prescription drug prices.”
The “your” refers to insurers, who bear costs for medical expenses covered under their plans. That puts insurers and Pelosi, at least in one sense, in alignment, as both have an interest in lower costs. Indeed, insurers regularly negotiate to lower their health care costs, but in practice their efforts have had little effect on the general trend in costs. Drug company patents give pharmaceutical giants outsized power to set prices, and hospital consolidation has also given providers more power in those negotiations. Even where insurers have been able to negotiate lower prices for their own customers, that has done little to shrink the list price of drugs for the public.
At the briefing, Primus mentioned three avenues that Pelosi, a California Democrat, sees toward lower drug prices, sources said. The first, the
CREATES Act, is bipartisan legislation, strongly opposed by Big Pharma, that would make it easier for generic drug companies to get access to a sufficient quantity of medications needed to produce generics.
The second measure addresses what’s known as “pay for delay,” in which a drug company pays a generic manufacturer to not produce a generic version of an expensive drug. Democratic leadership wants to ban that practice. The third revolves around the issue of “evergreening,” which is a pharmaceutical industry practice of extending patent protection for a particular drug through a variety of practices. Democrats want to restrict evergreening to encourage cheaper generics make it to the market faster.
Primus’s approach has a strong political logic to it, as taking on every health care stakeholder at once is arguably more difficult than singling out one industry and hammering away, even if the effort is out of step with where progressive energy is at the moment.
you know what, you're right. That dude has gone off the rails.