Daschle on Drug Costs: 'We Ought to Be Focused on Value'


This final segment of our conversation with former Senate Majority Leader Tom Daschle focuses on issues now before the U.S. Senate: Drug prices, the epidemic of opioid drug abuse and medical innovation.


EISENHOWER: In the remainder of this session the Senate is giving some attention to several health care issues. One of those is drug prices, which is become an issue on the campaign trail, in part because of these spectacular increases in drug prices. What do you see the Senate doing in regard to drug prices?

DASCHLE: Well, I don't know if the Senate is going to be in a position to come to any consensus at this point. There is, as you say, significant concern on both sides of the aisle, Republicans and Democrats. They're focusing on price, and, frankly Karl, I think we ought to be focused on value.

What is the value of a new drug? How much more quality of life can one be given with a certain drug? There's a difference between a drug that provides a cure and a drug that simply extends some freedom from some of the symptoms of a drug but doesn't really solve the problem. I think value really ought to be the focus. And I'm hopeful over time we can come up with innovative new approaches that allow us assess the value of a new drug as we look at the overall challenge we face with regard to price.

Price in and of itself doesn't tell the whole story.

EISENHOWER: But even when you're looking at value, especially looking at the new drugs that do provide a cure for hepatitis C, it's pretty clear that in the long run these drugs, in addition to saving lives, do save money. But that's expense that hits all at once as opposed to an expense that get paid over 20, 30, 40 years. How does the health care system deal with these sort of bow waves of massive expenses.

DASCHLE: You have two challenges. One is you have the actual price itself, and then the assessment of value as a result of that price. But then the second question, and you put your finger on it, is how do you finance these expensive new investments, and are there new ways? We look at the way we finance cars, and we look at housing finance in a separate way from the way we look at other expensive propositions in life. I'm not so sure that there aren't some possibilities for symmetry there and looking for ways to provide for innovative financing that allows us to extend payment over a longer period of time may be one solution.

I haven't seen any concrete proposals in that regard yet, but I do think we have to think innovatively about how we finance these life-saving changes to our drug medications.

EISENHOWER: Another issue before Congress now is the growing epidemic of opioid and heroin drug abuse. Why is this happening now and what can government do to try to turn things around?

DASCHLE: This is happening now in part because of availability and price. Again, I think costs themselves are a factor here, but the availability is so different from what it was even 10 years ago. So I think the combination of these factors, along with -- we talked earlier about the social media -- there's a tremendous network of information that I think has accelerated and served somewhat catalytically in bringing about greater use as well.

It's going to be hard for the government to come up with a comprehensive solution to the challenge, in part because in some cases there are very legitimate uses of these drugs. So drawing the distinction between legitimate use and illegitimate use is one of the challenges of government. But certainly, providing more information, having greater transparency, and making sure we have a massive education campaign about the extraordinary consequences of overuse is something the government should be involved in.

EISENHOWER: This is education for health care providers or education for consumers?

DASCHLE: I think a little bit of both, frankly. Health care providers, but especially for consumers.

EISENHOWER: One last topic I'd like to talk about is medical innovation, which has been a focus of Congress. On the House side they put together a 21st Century Cures bill that combines some changes in how FDA approves drugs and medical devices along with funding for medical research. The Senate is taking different approach and looking at these topics individually. What would you want them to prioritize? What does the federal government need to be focused on in the area of medical innovation?

DASCHLE: The thing I am very encouraged by in this context, Karl, is how bipartisan this whole effort has been. Health care policy has been so polarized in the last five years; it's actually refreshing do something in a bipartisan way, whether it's the repeal of the SGR, the sustainable growth rate last year, or the work on 21st Century Cures or its sister bills in the Senate.

Basically, I think we've got to look at both bench and translational research. There's a real opportunity for us to move forward. I think the president's "moonshot" on cancer is a good example. Its precision medicine approach is population health. How do we find ways with which to insure people can stay well longer? Putting more emphasis on good primary care. Those are the kinds of things that could have real traction and make a major difference in the impact and the quality of life for all Americans as time goes forward.

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