‘We’re Not Getting It’: Why Bernie Sanders Says His Dream of Free Medical Care for All Must Wait

Senator Bernie Sanders, who has spoken out against the inequity of the US healthcare system for decades, became the new chairman of the Senate Committee on Health, Education, Labor and Pensions in January. The job gives Washington’s biggest enemy to the health care industry an unprecedented opportunity to shape health care reform in Congress. But the radical change he seeks may prove elusive. Even Sanders admits that his powers are limited.

President Joe Biden’s address to the U.S. Congress Tuesday night showed how much of Sanders’ platform has moved into the Democratic mainstream, with Biden at times sounding like his former top Democrat foe lashing out at Big Pharma and its “record profits.” Biden boasted of measures taken to lower drug prices and stop surprise billing during his term and urged Congress to pass a federal expansion of Medicaid.

However, the radical change Sanders seeks may prove elusive. During a recent interview with KHN in his Senate office, the Vermont independent spoke about the prospects for lower drug prices, greater access to primary care, and his ultimate goal of Medicare for All.

The interview has been edited for length and clarity.

Q: What do you hope to achieve as chair of the HELP committee – in terms of legislation, as well as communications and investigations?

What I would ultimately like to achieve is not going to happen right now. We have Republicans in control of the House of Representatives. And a lot of the views that I have, including Medicare for All – I think if we had a vote tomorrow, we’d get 15 to 20 votes in the Senate and not win the House of Representatives. I understand it. But I believe that our current healthcare system is not working.

We spend twice as much per capita on healthcare than other countries, and 85 million people are uninsured or underinsured. It’s a dysfunctional system that I think needs to be drastically changed to Medicare for all, but we’re not getting that.

Q: What can you really do?

[From] a poll a couple of months ago just among the Republicans. Main concern? High cost of prescription drugs. It is high time for us to challenge the greed and outrageous behavior of the pharmaceutical industry in the most courageous way.

Q: There are so many confusing parts in the system – patents, 340Bs, pharmacy benefit managers, insurance formulary problems…

That’s right, there are a million parts to this problem.

Q: Other than the overhaul, what parts do you think you can change?

Every year the US government through [the National Institutes of Health] spending tens of billions of dollars on research. The Moderna vaccine was jointly developed by Moderna and NIH and has received billions of dollars in aid, guaranteed sales, and you know what has happened in the last couple of years. Moderna’s CEO is now worth $6 billion. All their top executives are worth billions. And now they are threatening to quadruple prices. This is a company that has been greatly supported by the taxpayers of this country. And this is one example of many.

What is the responsibility of a pharmaceutical company that receives very significant support – financial support, intellectual support for research and development – to the consumers of this country? Right now it’s zero. “Thank you very much for your support. I’ll charge you any price I choose.” We must put an end to this.

This is the starting point.

Q: But what is the mechanism? Entry rights, whereby the government can force a company to share its license for a drug that was developed with federal investment, allowing others to make it?

This is one approach. By the way, he was threatened by people from the administration of George W. Bush. Marching in is one option.

Reasonable pricing is another area. I made two trips to Canada: once, as a congressman from Vermont, I took a group of working-class women across the border to buy a cure for breast cancer; used to take people from the Midwest as a presidential candidate, and we bought insulin. In both cases, the price was one tenth of the cost in the US.

Another area is primary health care. I have worked diligently with other members through the Affordable Care Act and the American Plan of Rescue. [Act] significantly expand community health centers. FQHC [federally qualified health centers] provide primary care, dental care, mental health counseling and low-cost prescription drugs. About a third [people in Vermont] receive primary health care at local health centers.

Q: I was at a meeting between the FDA and the patent office, I heard from biosimilar companies, patients, etc., and much more. saying that the U.S. Patent and Trademark Office can’t do that much with patent thickets, and it would be nice if Congress did something.

This is one of the shameful tools that the pharmaceutical industry uses to make sure we pay high prices and don’t get generics. Yes, this is definitely something we need to pay attention to.

Q: Other priorities?

Health workforce crisis. We don’t have enough doctors, nurses, dentists, mental health counselors, pharmacists. The nursing crisis is huge. We have a hospital in Burlington, medium in size by national standards, the largest in Vermont. I was told they were going to spend $125 million on traveling nurses this year. One medium sized hospital! Meanwhile, we have young people who want to become nurses and we cannot train them. We don’t have enough nurses. I think we are getting bipartisan support on this issue.

Another thing I want to point out is dental care. There are not enough dentists, they are too expensive, they are not available in entire regions.

Q: Do you agree with President Biden’s decision to end the public health emergency in May?

[Frowns] I have some concerns. [Sanders appeared to be the only member of Congress wearing a mask during Biden’s speech on Tuesday.] This will again throw many more people into the uninsured.

Q: And things like vaccines will no longer be covered.

They would go to market. Our friends at Pfizer and Moderna want to quadruple their prices. So if you’re in doubt right now about getting the vaccine, and it’s free, what if it costs you $125?

Question: As you said, drug prices are a big concern for everyone. But among Republicans, there seems to be more inclination to press on pharmacy benefit managers or PBMs rather than drug companies. Is this an area where legislation can be?

You have insurance companies, PBMs, and pharmaceuticals. Everyone wants to blame the other guy. And yet they are all guilty. And we’re going to take a serious look at it.

Q: Is Dr. Robert Kaliff, Commissioner of the FDA, a good conversationalist for you?

A lot of work needs to be done with the FDA. Let’s just say I think it’s important that we take a close look at what they’re doing. They have some responsibility for pricing. This is part of the mission that they did not carry out.

Q: What about the problem with 340B? Accusations that hospitals are cheating the system.

Yes, it’s something. One of the first things [I did] When I was mayor of Burlington from 1981 to 1989, the hospital was stripped of its tax status. Because I did not believe that they were fulfilling their duty to serve the poor and working families. We had a lot of discussions and the situation has improved. At the moment, the criteria for obtaining tax-free status are extremely vague. This is a problem somewhere in the future that I want to address. If you’re not going to pay taxes, what are you actually doing?

Q: Do you have certain allies in any party?

I spoke today with a conservative GOP senator who will work with me on issue X, but not on issue Y. It depends on the issue. If we are going to succeed, we will need bipartisan support. And there is this level of support. I’ve talked to four of the 10 or 11 Republicans on the committee, and I’ll talk to the rest.

Q: Do you have a lobbying policy?

I don’t have lobbyists flooding my door. These lobbyists are efficient, well paid, and help shape the culture of where you’re going. My culture is shaped by interacting with ordinary people. I’ve talked to too many older people who have cut their prescription drugs in half.

I don’t worry about lobbyists. Worry about people dying because they can’t afford prescription drugs.

I don’t need some seven-figure-a-year guy to tell me about the drug companies’ problems. They have to explain to Americans why they made $80 billion last year and people can’t afford drugs.

Q: Are you going to invite pharmaceutical executives to the hearings?

We are considering all options.