We have the government controlling almost 46%, 47% of health care to begin with, and we don’t have an environment where there’s full transparency on pricing, and the competition is not there.

We want to create an environment where providers are competing for patients on the basis of cost and quality.

Davis: Another major development in health care is personalized care where people can get tests done that tell them about their particular bodies, health problems, and their needs based on the genetic makeup. This kind of innovation holds real promise for patients in the future.

How would single-payer or Medicare for All impact these kinds of innovations that are really helping patients?

Verma: Well, all of us use the health care system from time to time. I know my husband has a serious cardiac condition, so I’m very concerned about making sure that there’s innovation for anybody that’s dealing with the disease.

You always want to know that there is the hope of innovation and treatment and cures that are going to address your situation.

The concern I have is that the government has already had problems in the area of innovation. If we look at the Medicare program, it has problems with approving new treatments that come to market.

One example is insulin pumps for diabetics. They were insulin pumps in the market widely used in the private market. But when people would age into the Medicare program, the pump that they had been using for years was not covered by Medicare.

The reason why is because Medicare is prescribed in law and it takes an act of Congress sometimes to provide coverage for innovative treatments. The law was set up so long ago and it hasn’t been updated, and it says you can pay for supplies and you can pay for durable medical equipment.

But technology is changing so rapidly that sometimes it doesn’t fit neatly into the buckets that Congress has set up.

And so the agency gets stuck, and it took years for the agency to figure out how we can cover these pumps that were widely available in the private market. If we didn’t have a private market, you wouldn’t even have that type of innovation.

I think that’s an important point because if the private market, which is more nimble in paying for new technology, if they’re not paying for these things and we’re only relying on the government, innovators aren’t going to make those investments because they’re not going to get paid for them.

A couple of other examples are some of the new cancer treatments that we’ve had with CAR T. These new treatments came out, [the] private sector started to pay for it.

When they first came out, Medicare was not paying for it. It was a covered services people were using for. But Medicare didn’t have a rule or regulation to pay for it, because it was so new and so innovative, the agency is trying to figure out, is this a process? Is it a drug?

Because of that, because they have problems paying for new and innovative treatment quickly and rapidly, that creates access problems for patients.

Those are some of the things that the Trump administration is actually trying to address. The president wants to strengthen the program. He wants to make it work better for seniors and address some of those issues.

But if we create this bottleneck situation where every innovative device in America has to come and ask permission from one D.C.-based agency, I think we have a real problem in terms of creating investment in this country for innovation.

Davis: Well, it’s no secret that doctors are increasingly frustrated with the practice of medicine, particularly the regulations that keep them stuck on paperwork when they’d rather be delivering care to their patients.

Some younger doctors and practitioners say they like the idea of single payer because they think that will simplify [the] payment process and cut down on bureaucracy and paperwork.

Is that an accurate expectation? Or are there better ways to address their concerns?

Verma: Well, one of the things that I remind doctors of is some of the major issues that they’re facing today have been created by D.C. policies.

The issue of physician burnout and moral injury are very real, and I’m deeply concerned about this. We’re hearing rates have increased [of] physician suicide. Medicine has typically attracted some of the best and brightest in our country into this field.

Now, what we’ve turned them into is doing a lot of paperwork, a lot of bureaucracy, and … the vast majority of that has been created by D.C. government policy.

So if we look at, for example … the [Medicare Access and CHIP Reauthorization Act] program. That was a program that, thankfully, we got rid of this [sustainable growth rate formula that determined Medicare Part B reimbursement rates.]

But now we’re requiring our doctors to report all of these process measures that don’t mean anything to them and don’t mean anything to patients, but the government is putting all this extra work on them.

They’re seeing patients during the day, they’re reading medical journals, and then they have to sit and read all of these different regulations to be able to comply.

The other thing [is] … a lot of government policies over the last 10 years have created an anti-competitive framework for doctors, where government policies pay hospitals more than they pay doctors for the exact same service.

That’s why you’re seeing all these hospital systems buy up physician practices and physicians are losing their autonomy and they’re not independent practices anymore. That’s going in the direction where you have more and more employed physicians.

I think that’s what’s creating a lot of frustration in the fields.

But the root of that has already been government policy. You hear folks say, “Well, they’re going to have less paperwork.” Well, the government still requires authorization for services. The government still requires a lot, so that’s not going to go away.

I’m concerned that the government has not been sensitive to the impact of all of its regulations [on] doctors and putting them in a position where they can control everything. It’s going to make it worse for our nation’s best and brightest.

Davis: Well, we’ve talked about the health care system as a whole and competing systems like Medicare for All, which, of course, would require Congress to act in a major way. But as a member of the executive branch, what is the Trump administration doing right now to improve our health care system?

We saw recently that you made several announcements, one of them on price transparency. What are some of these things that you’re able to do from the executive branch that are improving things?

Verma: Sure. Well, our administration is focused on making sure all Americans have access to affordable, high-quality care.

Unfortunately, that’s not the situation today. The concern is that people are thinking we just need to have the government take over and do everything. Have the government pay for everything and all our problems will be solved. That’s just going to increase taxes.

I think the discussion needs to focus on, how are we going to address rising health care costs in our country?

The reality is the last 10 years of government intervention and D.C.-based solutions haven’t produced anything. They have not lowered the cost of health care in our country. And because of that, so many people can’t afford it.

The conversation from our administration standpoint is, we’re addressing the underlying drivers of health care costs. That’s why you see President Trump so focused on the issue of drug pricing because that’s where we’ve seen rapid acceleration in health care costs.

Big move on price transparency. We want to empower patients with the information that they need to make decisions about their health care. They should be making those decisions, not Washington bureaucrats.

We want to make sure they have price information, they have quality information, and they have access to their medical record.

The announcement on price transparency was requiring hospitals to post all of their negotiated rates. In that way, when people are going in for a service, there are many of our health care services that are predictable. Not all of them are urgent.

And so in those situations where you know you’re going to have a procedure, a surgery, whatever that is, you should be able to go on a hospital’s website and see what that’s going to cost.

It will allow you also … the way we’ve set up our proposal is it will allow you to look at other hospitals and to make comparisons, so do an apples-to-apples comparison.

I think it’s very innovative. It speaks to the president’s bold leadership. A lot of special interests won’t like this, but our administration is about doing what’s right for patients.

Davis: Well, this is a very informative and insightful, and it’s great to know what the executive branch is doing on this. Administrator, thank you so much for your time today.