Former House Speaker Calls for Overhaul of Health Care System During NASP Keynote Speech

Those who do not get involved in health care reform efforts to make sure their voices are heard risk ceding important decisions to those who may lack the insight to make meaningful change. This call for advocacy was the main focus of former US congressman and Speaker of the House Newt Gingrich during his keynote speech at the 6th Annual National Association of Specialty Pharmacy Meeting and Educational Conference.

“What you do back home, talking to your congressman, talking to your senators, introducing them to the reality of your profession, is really important. It’s actually more important than seeing them in Washington, [DC],” Gingrich told the audience. “Because when you’re back home, you’re in the middle of the people they represent. You’re in the middle of the reality they represent.”

The Trump administration’s recently released blueprint to lower prescription drug prices presented 4 broad strategies: increased competition, better negotiation, incentives for lower list prices, and reduced out-of-pocket costs. Gingrich told the audience that with change looming in the health care space, stakeholders must lobby their legislators to make sure informed decisions are made.

“The reality is that if the people who know something don’t get involved, by definition they leave the decisions to the people who don’t know anything. If you don’t come to Washington with all of your ideas, you’re allowing yourself to be governed by people who don’t know as much as you do,” he said. “So you’re spending all of your time complaining about how stupid the people are who take the time to make the decisions because you were too busy to make the decisions. So now you have to fight to undue the decision you know is dumb because you didn’t spend any time to make it right.”

Gingrich said when he stepped down from the government, he began to focus specifically on the causes of national security and health care, both of which he called very expensive and a matter of life and death.

“What surprised me after I got into them is that health care is 10 times more complicated than national security. You take Iran, North Korea, nuclear weapons...you name it, and put them all in a box, the health care box is 10 times bigger,” he said. “How do you back out of this mound and begin to make sense of it? Health care is essentially a moral issue. You can’t deal with health as though it’s purely economic. It’s about your daughter, your grandmother, your brother. You get the hardest cases with the greatest complexity and the greatest need for technical accuracy.”

After spending a few years talking to stakeholders throughout the health care system, Gingrich said each individual element is ruled by self-interest. As such, he called the current system a mess that gives rise to people calling for changes that may not be ideal in the long term.

“The reason you have so many people who are willing to say they like Medicare for all or government-run health care is they’re just tired,” he said. “They’re confused. They don’t see how they can get it to work. So they say, ‘If only the government would run it, then I could relax.’ Those of you who have watched the government close enough know the idea that the US government is going to successfully run the system is pretty dubious. But it’s partly just exhaustion from the sheer complexity.”

Gingrich told the audience that one of the main problems fixing health care has been Republicans spending time and energy pushing back against the calls for government-run health care instead of fixing the current system. “It’s very clear what we want to have is a system that offers the average American the longest possible life, with the best possible health, at the greatest convenience, at the lowest cost, using the newest information to maximize their lifespan and to minimize their inconvenience,” he said. “That’s the system we want, not the system we have, and I don’t believe the government can deliver that system.”

Gingrich pointed to the Centers for Medicare and Medicaid Services, which he said is a huge bureaucracy comprised of career professionals, with a thin layer of political appointees who lack the insight into the various individual health care sectors to achieve meaningful reform. He said there is a need to determine a series of steps that can work in concert to fix a system he called “profoundly misdesigned.”

“On the left, you have a continuing mantra that says you have to have a government- run system, and the great temptation for Republicans is getting sucked into saying ‘no,’ which I think is not productive,” Gingrich said. “Because the average person knows there are things wrong with the system. And if the choice is going through a brand new effort with the government or not changing anything there will be tremendous pressure to go with the government. But in fact, if we come in and methodically change things, figure out how it ought to operate, I think that could have a huge impact.”

Gingrich noted that pricing transparency has had a significant impact in lowering costs for purchases such as airline tickets and hotel rooms. He said similar transparency in health care, along with eliminating pharmacy gag clauses and drug rebates, could help to reduce costs. Gingrich was especially critical of the rebate system.

“While a rebate is a useful tool for negotiating sales, so is lowering the price. If you didn’t have rebates, people would actually have to lower the price,” he said. “One of the things we’re pretty sure of is that rebates actually drive up the price over time, because the higher the price, the bigger the rebate.

“There will be people who fight over this, but my hunch is you’re going to see momentum build toward getting to real pricing and real transparency. I hope you’re going to see a very dramatic shift in how we think about expensive, but successful, interventions.”

Gingrich used Alzheimer disease as an example of an area desperately in need of innovation. He said current cost estimates project $20 trillion on private costs in the Alzheimer space by 2050. He said a breakthrough that delayed the disease by just 5 years could cut that cost in half, yet there is not the drive nor the intensity in investing in this space that a $20-trillion cost center would suggest.

Gingrich closed saying that during the welfare reform process, legislators met with key opinion leaders and stakeholders in the space on the state level to go through the various details of the plan to determine what did and did not work. He said that a similar effort is needed to achieve a successful overhaul of the broken US health care system.

“We need your thoughts, your inventions, your ideas. Don’t assume some people in these big buildings [in Washington, DC] living in an abstract world, reading the Washington Post, sitting around all day in a world of paper, are necessarily going to come up with solutions,” Gingrich said. “You can have a huge impact on the system. It’s a remarkably open system. Its great problem is not the lack of money. Its great problem is the lack of ideas, and you can play a major role."