Trump’s New Man at HHS

President Trump’s nominee to be the next HHS Secretary—Alex Azar—has a sparkling resume and by most accounts is a practical, accomplished and solid choice to lead the agency and the federal government’s health programs for at least the next 3 years.

He served as HHS Deputy Secretary under George W. Bush.

But the choice is yet another by the Trump administration that puts industry leaders in charge of public policy and programs.   And in this case that could matter as much as the appointment of Scott Pruitt to head the EPA—although I do not equate the two personally since Pruitt is a severe partisan with a disdain for the federal government while Azar apparently acquitted himself well while serving at HHS under Bush.

The problem is Azar spent most of the last 10 years at pharmaceutical giant Eli Lilly and was president of Lilly’s U.S. affiliate before leaving that post in January. He also served on the board of the biopharmaceutical industry trade group BIO.

Potentially most troubling, Azar worked at Lilly when it was accused of colluding with other drug companies to set high prices for insulin over years. Class action suits and probes of insulin pricing by attorneys general in multiple states remain underway.

“Eli Lilly is one-third of an insulin cartel that has driven up prices by more than 300 percent,” said a statement by the consumer advocacy group Patients for Affordable Drugs (P4AD). (patientsforaffordabledrugs.org)

Axios’ Bob Herman reports that during Azar’s tenure at Lilly, which involved many appearances on Fox Business, he toed the drug-industry line that insurance companies are also to blame for accelerating drug pricing. LINK :   https://www.axios.com/alex-azars-industry-history-shapes-health-care-positions-2509129076.html

“The issue shouldn’t be just to focus on drug prices….the issue is what are people paying when they go to the pharmacy,” Azar said in one TV appearance.

While insurers and PBMs play a major and sometimes self-dealing role in the complex system of drug pricing, many independent analyses show that the main reason drug prices are increasing is because drug companies are raising prices as much as the market will bear. That market is broken for the rest of us.

P4AD’s executive director Ben Wakana said in a statement: “To have a former drug company executive nominated as HHS Secretary adds to our concern that this administration may continue to disappoint through its lack of action on skyrocketing drug prices.”

Indeed, despite saying on numerous occasions that he’d tackle the drug price issue—even accusing the industry of “getting away with murder” on prices—Trump has so far failed to follow through.

Yet, with characteristic chutzpah, Trump’s tweet announcing Azar’s nomination said: “He will be a star for better healthcare and lower drug prices!”

 

Is that possible?   One school of thought that emerged this week in the coverage of Azar’s nomination is that it’s feasible—in a “Nixon goes to China” way—that Azar is the perfect man to take on the drug price issue.

 

As a lawyer, he knows the laws. He knows his way around HHS. He knows the Washington system. He knows the drug industry and policy. He knows how drug prices are really set.   He could be the one to leverage and channel Trump’s initial outrage about drug prices (which was probably sparked by the New York tabloid’s coverage of rogue pharma executive Martin Shkreli and not by any close study of the issue).

 

So, one could be generous and hopeful and take the view that Azar will see this once-in-a-lifetime opportunity to break through the logjam created by pharmaceutical lobbying and get some real reforms done that benefit the American public.

 

Unfortunately, with Azar (his confirmation is all but certain) and other pharma-friendly folks in high places in the administration, there’s probably little chance of action on drug prices—despite the fact that Americans consistently rank it among their top health care priorities.

 

Coincidentally, The Washington Post published a piece this week about Joe Grogan, director of health programs at the White House’s Office of Management and Budget and an executive at Amgen and Gilead Sciences before joining the administration. The gist of the piece: no change in health policy will get implemented without Grogan’s approval.

LINK: https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/11/13/the-health-202-the-trump-appointee-you-ve-never-heard-of-who-s-reshaping-health-policy/5a05e5fa30fb045a2e002f8e/?utm_term=.6c9ea410495d

 

While depressing, it’s naïve to think Azar and Grogan won’t have their eye on the possibility that they’ll be out of a job come January 2021. That’s the problem with the revolving door of working for government then industry then government, etc. And it’s the problem with hiring industry executives in general for high-level government jobs. In the U.S., the lure of money in industry at those high levels is only rarely diverted or decreased by serving the public interest through well-wrought and well-balanced regulations and laws.   In addition, if they are Republicans their first allegiance is to business-interests anyway.

 

On other health care issues, Azar will be a stalwart Republican.   He opposes the ACA and has said it needs significant changes. Democrats will query him intensively on that.   In June he told Bloomberg Television: “One of the nice things…is [the ACA] does give tremendous amount of authority to the secretary of HHS.”

 

He also supports Medicare and Medicaid entitlement reform, including block grants to the states for Medicaid.   On the other hand, during his tenure as HHS deputy secretary Azar pushed for greater disclosure to consumers of medical and health care prices.

 

Azar was probably a smart choice for Trump but it remains to be seen whether he’ll a good choice for long-term sound health care policy and the public good.

 

 

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