Special Episode: Bipartisan Rx for America’s Health Care – A Second Opinion Podcast

Special Episode: Bipartisan Rx for America’s Health Care

I’m here today broadcasting from the Bipartisan Policy Center in Washington, DC, where we are releasing a major report that has been three years in the making.  For listeners who may not familiar with the BPC, it is a Washington, DC-based think tank that actively fosters bipartisanship by combining the best ideas from both parties to promote health, security, and opportunity for all Americans.

Now I’m sitting down with two of my “Big 10” colleagues, Chris Jennings, who most recently served as the Deputy Assistant to the President for Health Policy and Coordinator of Health Reform under President Barack Obama, and Dr. Gail Wilensky, an economist and the director of the Medicare and Medicaid programs under President George H.W. Bush.  They are going to share how the sausage got made on this health care reform compromise, and highlight some key details in the report.

Bipartisan Rx for America’s Health Care

Read the “Bipartisan Rx for America’s Health Care” – a detailed way forward on healthcare reform by leaders from the Bipartisan Policy Center.

Senator Bill Fr…:           Welcome to A Second Opinion podcast where we are rethinking American health. I’m your host, Senator Bill Frist. To make sense of all the dynamic perspectives in healthcare, you need a trusted source engaging at the intersection of policy, medicine, and innovation. You need A Second Opinion, a podcast where it all comes together. I’m here today broadcasting for the Bipartisan Policy Center, the BPC in Washington D.C. where we are releasing a major report that has been three years in the making. For listeners who may not be familiar with the BPC, it is a Washington D.C. based think tank that actively fosters bipartisanship by combining the best ideas from both parties to promote health security and opportunity for all Americans. It was founded in 2007 by four majority leaders that proceeded me, Howard Baker, Tom Daschel, Bob Dole, and George Mitchell representing two founding leaders from each side of the aisle. The BPC prioritizes one thing above all else, getting things done.

Senator Bill Fr…:           I serve as a senior fellow at the BPC and co lead its health project with Senator Tom Daschel. In 2017, in the midst of the Affordable Care Act, repeal and replace debate, we decided to take on the Herculean task of creating a truly bipartisan approach to healthcare reform. We brought together a group that we affectionately call the big 10 consisting of five Republicans and five Democrats who are each leaders and experts in health and healthcare. Today’s event and report release are the combination of three years of tedious negotiations and heartfelt compromise that brought us to this point in time.

Senetor Daschle:          Today we announced the release I’ve recommendations by the Bipartisan Policy Center’s future of healthcare initiative. For three years, my colleagues and I have worked to find common ground to make health insurance more accessible, more affordable for all Americans.

Senator Bill Fr…:           Our work on this proposal together not only shows these problems can be addressed, but demonstrates that people with diverse, with varied political and policy interests can work together to find agreement. Yeah, and really only if they are willing to put the health of the people first. We humbly agree that there are many, many different paths to get to this end point. There are many different paths besides our proposal that you could get to that end point, but our experience over the last three years of working together has absolutely convinced us that if members of both parties coming together in the same room and if they reject political polarization and if they embrace the notion of bipartisan compromise, they can secure those healthcare policy advances. They’d in truth rationalize our healthcare system and benefit the very people that it serves.

Senator Bill Fr…:           You just heard Senator Daschle and then me kicking off our event called Future of Healthcare. And that was on February 5th at the Washington Marriott where we unveiled our report. Now I’m sitting with two of my big 10 colleagues, Dr. Gail Wilensky, a nationally recognized economist and the director of the Medicare and Medicaid programs under president George H. W. Bush and Chris Jennings, who most recently served as the deputy assistant to the president for health policy and coordinator of health reform under president Barack Obama. They share the backroom story of how this remarkable compromise was reached. They described the tough and grueling art of compromise in health policy, something I believe the American people would like to see a whole lot more of. And now please join me and our guests for A Second Opinion. All right the bipartisan prescription for America’s healthcare, ideas action results a practical path to reform. February, 2020, released today at the Bipartisan Policy Center. And let’s just start at the very first, where did the idea of come from?

Chris Jennings:             It’s sort of a reflection of the frustration that many people had about the polarization and lack of progress anywhere in health policy. And remember this has happened, we’re now, as we speak, in the 10th year, we’re at a 10th year anniversary of Affordable Care Act and we still haven’t had any significant reforms of the underlying legislation, which is nothing that we’ve ever seen before in the Congress. So there was a belief, and this was something that RWJ felt pretty strongly about. Is there anything that we can do to kind of start moving the ball forward again? And they had good luck with the Bipartisan Policy Center in 2008 and 2009 when we released our last big health reform policy and they decided to re up for this again three years ago and asked for a similar collection of well respected but politically pragmatic, realistic people on both sides of the aisle to develop some policy solutions and see even without knowing whether this was possible, if we could come together with anything that could lay the predicate for potential change.

Senator Bill Fr…:           So a three year history that is actually produced today, released today, and as was pointed out today, that’s just the beginning. You get 10 people, five from each party, and we can talk a little bit about who they are, but coming together with a group of proposals and how did it go over the last few years?

Dr. Gail Wilens…:         You know the important part isn’t just that there are five Republicans and five Democrats because that is not so un… It’s unusual in Washington, but it’s not so unusual. So the really unusual and noteworthy aspect about this effort. These are Republicans that go across the ideological spectrum from being quite conservative to being moderate. And the same with the Democrats. It’s not just that there are five Democrats, it’s that they also go across the spectrum from moderate to very liberal and it’s recognizing that if you can’t get representation, not just across the parties, but you can’t have everybody sitting in the middle of the arrow or the middle of the D part and think it’s anything that’s going to go forward.

Senator Bill Fr…:           I want to pause and give our listeners some background on the 10 members, five Democrats and five Republicans who made up the future of health care initiative and crafted the bipartisan recommendations you’re going to hear more about. Our group was co-chaired by me, Senator Tom Daschel, former Medicare and Medicaid director, Dr. Gail Wilensky and Andy Slavitt, former acting administrator for the Center for Medicare and Medicaid Services. Gail and I represented the Republican perspective. And we’re joined by Sheila Burke, former chief of staff to Senate majority leader, Bob Dole and deputy staff director for the finance committee, which is responsible for legislation relating to Medicare and Medicaid and other health programs. James Capretta, who holds the Milton Freedman chair at the American Enterprise Institute and he’s a former associate director at the white house’s office of management and budget under president George W. Bush.

Senator Bill Fr…:           And Ovik Roy, trained as a physician at the Yale University School of Medicine. He has advised numerous Republican presidential campaigns on healthcare policy and is the founder and president of the Foundation For Research on Equal Opportunity. Tom and Andy were joined on the democratic side by Chris Jennings who is here with us today and as I mentioned, spearheaded health policy under president Obama. Cindy Mann, who served as director at the Center for Medicaid during the implementation of the Affordable Care Act. And the late great Alice Rivlin, a brilliant economist who led both the congressional budget office and the white house office of management and budget. She made passionate contributions to this initiative before her passing in May of 2019. As you just heard Gail stress, it is exceptionally rare to have so many Republicans and Democrats with such deep policy experience across the ideological spectrum come together to forge a solution. But that is what we did.

Senator Bill Fr…:           And now let’s get back to the episode. Tell me just a little bit about that because it’s interesting, the story behind the story of this is one of lots of conversations of people say, is it a consensus report. Did you all sort of lock arms and say, we’re just going to put it out there? Did you all vote 100%? Behind the scenes, what did go on? Was it meetings or was it emails or was it telephone calls?

Dr. Gail Wilens…:         All of the above.

Senator Bill Fr…:           Okay.

Dr. Gail Wilens…:         I mean it was a lot of contact. Even at the very end in December as we were getting ready for this February release, there were a couple times it looked like we might blow this all up, where people started challenging language or challenging some of the specific recommendations and fortunately there were enough cool heads on the group to step back to try to reflect the conversations that we had when we were making some progress. There were some areas that we thought did not have to be taken up initially, like what to do about longterm care, this was really focusing on expanding coverage, access to care and trying to restrain spending largely, but not entirely, by increasing competition where that was feasible, but to recognize that, it’s not always possible to do that and therefore to look to regulations, particularly in areas like surprise billing. That’s caused so much frustration to people when they go to in network hospital for an emergency, they think they’re covered, only to find out that the physician that saw them, it’s certainly important.

Senator Bill Fr…:           Oh, sure. And those are the sorts of issues, and we’ll go through several, dig in a little bit. Let’s take a moment to walk through the key elements of this bipartisan prescription for Americans health care. We decided to focus on improving the current system, improving it rather than recommending a complete overhaul because we all agreed that this proposal would be pragmatic and realistically achievable in this politically polarized environment in which we live today, and it’s also meant to reflect the perspectives and effectively address the concerns of the majority of Americans. Indeed, in a recent Bipartisan Policy Center poll, nearly 40% of voters said improving the current healthcare system was their preferred healthcare reform approach. Ahead of the more extreme positions of both Medicare for all and the repeal and replace of the Affordable Care Act. So what’s in the report? Our recommendations are extensive, so I highly recommend you read them in full at the BPC website bypartisanpolicy.org or on our podcast website, asecondopinionpodcast.com. Here are some highlights just to give you a feel for what we believe is achievable.

Senator Bill Fr…:           First to lower costs for consumers, employers and employees and government. We limit hospital charges in markets when mergers increase prices, promote generic drugs to increase competition at the prescription market in surprise medical bills by limiting charges from out of network providers in network facilities, establish a reinsurance program for individual insurance and marketplaces, restore cost sharing reduction payments to stabilize premiums and lower costs by increasing financial responsibility of drug companies and Medicare part D plans. To improve access to coverage, we, expand subsidies in the middle class to make individual insurance more affordable. Auto enroll subsidy eligible individuals in marketplace plans and allows States to keep adults in Medicaid regardless of midyear income fluctuations or paperwork delays.

Senator Bill Fr…:           And finally to accelerate the move to value based care, we promote collection of price and quality information through all payer claims databases, promote value based care in Medicare and Medicaid by modernizing the stark law and any kickback statute. It’s important to recognize that these recommendations do not represent the least common denominator of policies. As my friend and coach here, Andy Slavitt explained and I quote, “While it would not be the first choice of either party, if they alone were designing the system, it represents a strong bipartisan package that has something for each of us to love and perhaps other policies that we doubt.” And now let’s get back to the episode. Our viewers right now are around the country, the viewers and listeners and obviously what they see mainly is Washington D.C. on show and with the current administration, that’s compared to a reality show all the time, the state of the union message people refer back to.

Senator Bill Fr…:           But in terms of the reality of what goes on here, we’re in Washington right now, but how different is this sort of dialogue? It’s gone on over a longer period of time, facilitated by the Bipartisan Policy Center, the BPC. Funded by the Robert Wood Johnson Foundation, totally independent, a fantastic foundation and, I am on the board of it, so I have to be careful, my conflict of interest, but they didn’t ask any questions. They said go out, put these people in a room together and come up with a product. We’ll see what happens. How unusual is it compared to all the other activities that you do?

Chris Jennings:             There’s one other thing that I would agree with everything Gail just said. And on top of that there was a selection process to make sure that it was people who had actually succeeded in the past in getting something done and knew enough about health policy that, without having engaged in long educational seminars, you can go quickly to, well we know we can’t do this, we know we can’t do this, but we may be able to work on this. And, you get into those types of discussion, you can accelerate conversations much more quickly. You can also call sort of BS on one another if there’s a little bit too much play acting on one side or the other. So in a way I think it’s not just the spectrum of the ideology, but it’s the experience of the policy development process. That was really key.

Chris Jennings:             Maybe the other thing is there are other attempts that have been made and I know one in particular recently that just blew up and perhaps one of them is because we’re a step removed from having a direct and only one issue priority. And when you are a member of Congress, there is a lot of stakeholders, in Washington we call you stakeholders if we like you or a special interest if we don’t, but, we know them, we all know them. We all know their arguments, but I think we’re kind of a step removed where we can filter them in without reaching a point of gridlock or just say no or this is the time we’re just going to walk away. There was a really significant document I think, are the people who are participating to try to get this thing done.

Senator Bill Fr…:           And for our listeners on the podcast and our viewers on our website, we have a list of who those individuals are and their backgrounds. So I know people are curious, well who are these 10 people? And without going through them that’ll be listed there as well. How would you answer that question in terms of how unique this is? You don’t want to overstate it, but it was pretty remarkable. Being on stage today having a conversation and it’s something America doesn’t see. And I’m living in Nashville and I’m around the country as you are, but I know what kind of news people yet. And looking back and one of the reasons that I participated in the BPC, it gave that opportunity to do something like this, but lots of people are trying to do things. How unusual is this experience that you’ve had with these 10 of the last three?

Dr. Gail Wilens…:         I think there was something that Chris was just talking about that was very important to the success of this activity and that is BPC has a separate group of people representing industry, the hospitals and the large groups of providers, physicians, clinicians or others and it’s separate from our group of policy people who have had experience both in the real world so to speak and in Washington. Of trying to make change happen. I think having this separation is wise. It allows diversity of opinion and thought but enough commonality of interest in background that policy people can kind of duke it out at the policy level and the industry people can duke it out at the industry level without trying to put everybody in the room and come to some kind of agreement. That might’ve been a step too far. So I think you need both. I’m not sure you necessarily need both at the same time. In the same room.

Senator Bill Fr…:           And then where is, because both of you do a lot of speaking, you’re out around the country, you are policy experts, you’ve been through eyes of the needle, many of them in the field of health and health policy. Where is that sort of more integrating function take place?

Chris Jennings:             When the marketplace fails to achieve for a consumer, i.e. the public, they then come back to the policy community and they come back particularly to elected leaders, federal, state, local. And I think that’s where we’ve come from, which is, you are an elected leader, we were appointed but we had to be responsive to the public as we were dealing with the stakeholders. And I think that maybe gives you a sense of who they all are and how you navigate it through. But to Gail’s point, if you want complete consensus for all those stakeholders out there, their primary objective is pretty much status quo. They fear excessive disruption, particularly for something they can’t control and usually they succeed in achieving that. But there are moments such as now, which I think is the issue that drives this debate, which really was the central focal point of this report, which is issue of cost and complexity and affordability. And so you see, I think a newer focus, maybe a more intense focus in this particular report on that issue.

Dr. Gail Wilens…:         It is easier in Washington to get a no than to get yes.

Senator Bill Fr…:           Yeah.

Dr. Gail Wilens…:         And so it took a sustained commitment to find those areas where we could get a yes and a willingness to say we’re not going to go away without this.

Senator Bill Fr…:           Yeah. So when you walk into a Senate office and talk to the staff, not as individuals now, but with the report in hand and content is good as 10 people could come up with the excellent staff. Is that any different than walking in as Bill Frist or Chris or anybody on our group?

Dr. Gail Wilens…:         I think it is. And I think the reason is because the 10 of us have been around in our individual and professional capacities long enough that even if we don’t know all the individual staffers anymore because people come and go, they know about us, our reputations, they proceed us and recognize the importance of having a collection of individuals like us be able to come to some agreement.

Senator Bill Fr…:           I’m thinking more of the impact. That’s the thing. Because kind of some people can say so what?

Chris Jennings:             Yeah.

Senator Bill Fr…:           We got the why.

Dr. Gail Wilens…:         Yeah.

Senator Bill Fr…:           We got the why and we’re jumping on that, but the so what can again, this exercise have an impact going forward, it’s different.

Senetor Daschle:          Actually there’s a couple of audience. Yeah, I think it’s different in the sense that number one, there is an audience just of curious people in the public and the media who are like, if this thing crazily called bipartisanship work by people who know something about what would it look like? Okay, there’s just some inquisitiveness already and you get that all the time. We all get that, what would it be? You really don’t know until you go through this process. And I think that’s a very useful thing. And some people will say on both sides of the party, the basis of both parties, I’ll say, that took you three years to come up with that Jesus.

Senetor Daschle:          Let’s go someplace else. Now what they’ll find is as much as that makes them feel good, they don’t see a pathway to get it to enactment and execution. So then they come back. So one is just a core, what does it mean? And I think that’s an important contribution. But the second is, if I’m a member or a key staff, and we all know this, this is a policy, a broad set of policies that talk about many aspects of healthcare costs and delivery and markets and such that crossover multiple jurisdictions of these committees of jurisdiction, they frequently are in their little silos-

Senator Bill Fr…:           Silos yeah.

Senetor Daschle:          … as you know. The leadership, Pelosi, McConnell and the Rankers, they said, well, what would it be if I can finally get these committees to work together? That too is an interesting thing. And lastly, if I’m a professional staff person on Capitol Hill, it serves as an anchor, which is to say are we going too far one way or the other? And what did they learn by going this process that we can apply there. Now does that mean that that’s the end all be all, everything? I don’t think so, but I do believe it is unique and it’s value add.

Senator Bill Fr…:           I’m curious, again behind the scenes, how much does a language matter. Language, PR firms, communication firms here that are huge build around languages. But in terms of health, if we’re centering on the patient and health of the patient, we all have our biases, political biases and beliefs, but how much and just the conversation, the behind the scenes, the emails going back and forth. We all kind of knew each other, know each other. But how important is language?

Dr. Gail Wilens…:         Language is important.

Chris Jennings:             In policy, political speak. You can say something, if I said to Gail, I really think we should do some price controls here. Okay, well that, I mean, what population do you think, I’m not going to talk about price control, but if you said, where markets fail, should there be some federal role to limit, the bandwidth of what the private sector can do and which, by the way, we do in the MA program to where they use the Medicare program, they’d say, okay, maybe that’s workable. What’s unique about this group is I know without having to say it, to watch Gail cringe. Don’t do it.

Senator Bill Fr…:           That’s right.

Chris Jennings:             Okay. And she probably would say the same thing. I’m really in this block grant, it’s just the cap program. It’s just fiscal discipline, get over it. And we like, in our group, we’ll just go crazy. Right? And by the way, one other point about language, language is important internal in the policy, political community, in the healthcare community. But it’s also, which is why it’s so complicated, is it’s also very important to the public. But those are two very different lines of communication you need to connect with. Right? And great example of that is, and we’re in Washington, we talk about costs, we’re talking about cost to the program, cost to the government and cost to taxpayers. Talk to the public, the only thing they care about is was their premium and their copayment is going to be.

Dr. Gail Wilens…:         What does it cost them.

Chris Jennings:             What does it cost them. And if you’re not connecting these two together, then you’ve really lost the public. So to your point, language is absolutely critical.

Senator Bill Fr…:           Again, on the website, we have listed the policies but let’s run through some just quickly and literally 30 seconds just to give our listeners a flavor for what I have right here with me. But also what we’ll be talking about over the next couple of years as we talk to other policy makers and staff. So let’s just take them, say Medicare, we don’t want to talk about them at length, but what’s one thing in here that has to do with Medicare?

Dr. Gail Wilens…:         There they are both for the Medicare patient and for the providers or services. For the Medicare patient. It’s making sure they understand the options they have available. Traditional Medicare and Medicare advantage, which is coordinated care plans. That it has to be in language that’s clear. It has to be easily accessible to them. When it comes to the clinicians or the institutions, we need to make sure it is operationally feasible what we’re doing to them or the constraints that we’re putting on them and they have to be able to know in a predictable way if they engage in some activity, this is allowed or it’s not allowed, they’ll be reimbursed or they’ll be challenged. If there isn’t that kind of reasonable expectation. You can’t expect to have clinicians or institutions involved. They need to make sure they can continue, but they also need to be able to feel comfortable that they’re being responsive to the patients that they serve.

Senator Bill Fr…:           So in the here you have an affirmation of that and then specific policies-

Dr. Gail Wilens…:         On very specific policies.

Senetor Daschle:          The way we pay for compensate pharmaceutical companies and others for their prescription drugs and how we manage the program is really irrational. The incentives are so misaligned. And so as an example of some of the policies, people are saying, what’s the number one issue right now? It’s out of pocket costs. What’s the number of big issue? Driving out podcasts in their view is prescription drugs. For seniors who spend a lot of money, even when they reach this so-called catastrophic threshold, they’re still paying 5%. 5% of $100000 drug is a lot of money. Right? And there’s disincentives for the program to aggressively negotiate for the lowest price because of the way we just basically say, we’ll write you a check if it costs more than a certain threshold amount. Well that makes no sense.

Senetor Daschle:          So again, this is not an interesting, not so much a partisan issue. It’s a stakeholder issue, right? But we’re thinking Republicans and Democrats, interesting, they’re saying, let’s lower what we pay for catastrophic costs than the government pays, have the plans be more aggressive at negotiating them? Get saving from the savings from the government, lower the catastrophic burden that seniors are facing. And you can do all that in a more rational structure system without even getting into maybe something. I would like to do more of it, which is actually look at the prices themselves because I think even in some cases with those restructuring, we’ll still have high prices. But the point is that, and something Gail and I talked earlier about was the drug are administered and physician’s offices it’s so-called part B as in boy program is misaligned as well because we, in an essence pay the physician dispensing a drug a higher amount for dispensing a higher cost drug and it’s sort of a-

Dr. Gail Wilens…:         Which makes no sense.

Senetor Daschle:          Which makes no sense. So we have a specific policy where we alter that. And while it just seems so common sense, we’ve been talking about this for years and years and years because both the pharmaceutical industry and some of the specialists, physicians feel strongly that works to the end. And this gets to the point about many people like to retain the status quo, but when it starts hitting taxpayers and beneficiaries in such a way that it creates a political pushback. It provides the cover for policymakers, politicians, elected leaders to actually do something about it and hopefully this plants the seed what we’re doing today and provides more political cover and policy rationale to do just that.

Dr. Gail Wilens…:         And we’ve tried to give specific examples like in the case of drugs, that using a common name between the generic and the branded name so that people understand that these are one in the same and you can force some competition by recognizing them. Whereas if you keep separate names, people aren’t going to understand that they’re effectively the same. There’s some problems that are harder to sell in that when you get a patent, which you need to encourage investment in risky activities, you’re granting a monopoly. We accept that basically, you want to try to not prolong it longer than you need to and to promote competition with similar drugs or similar devices so that even though there’s a patent on that one specific activity, that doesn’t necessarily mean there can’t be competing other products within the same general area and that’s really the kind of competition that we’ve talked about promoting, recognizing the importance of maintaining some protections so that you get continuing investment in the future, but their common theme is using competition where it can work to try to lower price and having protections in place where competition isn’t going to work.

Senator Bill Fr…:           Yeah. That’s a great example of the sort of tension as you have both sides. Again, you want to protect the patient. You want to affirm the patient’s wellbeing at the same time you want innovation, you want new discovery, you want the cures that are out there that we all hope for. Let’s close with an area that was really hard for you to say, okay, I guess, it’s all part of saying we’re not going to accept partisanship, we’re going to come at it with bipartisan compromise. Bipartisan means less things to a lot of people, but it means we got two different parties in there. The compromise part means you have to give up things and you can either be silent on it and it’s pretty easy to give up. You’re going to say we’re just not going to talk about it. And there’s certain issues that we are addressing elsewhere. That’s the case. But is there one issue that you can recall that was really hard and if you read this, you say, oh gosh, I shouldn’t have compromised quite that early to get there.

Dr. Gail Wilens…:         Well for me as an economist-

Senator Bill Fr…:           It came really quickly. Okay.

Dr. Gail Wilens…:         Yeah. Well, it was the current tax exclusion. An employer sponsored insurance has frustrated me for maybe four decades now.

Senator Bill Fr…:           Big number, $173 billion last year we saved.

Dr. Gail Wilens…:         Because it is both inefficient and inequitable, it’s worth more the higher your income to exclude what is provided by the employer. And it’s inefficient because it encourages people to take more of their compensation as a fringe benefit. In particular, this fringe benefit that is health insurance. And that’s really not a healthy state because we know once people have insurance, they will tend to use more. That’s part of what insurance does. Having a more rational approach to this exclusion helps a lot.

Senator Bill Fr…:           That’s the direction you wanted to go in. What ended up in the report is that not for too much.

Dr. Gail Wilens…:         It’s a baby step in the right direction. It is talking about the importance of employer sponsored insurance and the need to rationalize how it is provided. So it recognizes the issue, I would have liked a more aggressive approach.

Senator Bill Fr…:           Yeah. All right Chris. I’ve heard many cases [crosstalk 00:35:05].

Chris Jennings:             I think that there’s two ways of looking at it. The things that I wish we did and we just didn’t do because the other sides wouldn’t do it. That was very frustrating. I look at this and I think, there’s so many other issues that we’re not addressing and partly that was because we couldn’t get consensus on, a lot of them have to do with more generous tax credits to make healthcare more affordable, from my perspective, more aggressive work on doing something on drug costing, that’s not in here the way I’d want it. On the other side of the things that I kind of grin and bear, more health savings, account incentives, that sort of HSA stuff. I mean, at a time when people are complaining about higher and higher deductibles, it just seems to make no sense that we’re going in that direction, but that is important to some people and then you want to reaffirm some of those interests. I would say my biggest wins were keeping bad things out and my biggest losses were not getting good things I wanted.

Senator Bill Fr…:           I love both of your comments because it really does capture the tension and the frustrations of compromise. It’s easy not to compromise. That’s why partisanship is so easy.

Chris Jennings:             Yeah.

Dr. Gail Wilens…:         Yeah. And feels good.

Senator Bill Fr…:           It feels good. You can leave and slapping people on the back, but the process itself, and it’s sort of, again, three years, it takes time to develop the relationships to allow them a tour. But once you get there, you can always say, I didn’t get quite enough, but that is the art of compromise and I think if there’s one thing that we’ve all learned is that it’s a real process. It’s the reality that goes on the Hill throughout the Hill, but especially in the legislative branch where you’re voting up and down on votes itself. And then I think just the last issue because it’s come up in our discussions, is the whole equity issue.

Senator Bill Fr…:           It’s really interesting if you began most of the debates. So what’s best for the patient in terms of equity itself, equity within this larger realm and equity means different things to different people and what ethical construct you bring to the table, but still just beginning that conversation with that framing does help bringing people back with that focus on the individual and their wellbeing and lifting them up with the pluses and minuses of the policy and the biases we have. Well, listen, there’s so much we could talk about. Again, we have a lot on the website itself about the details of the program, but this has been very useful to capture the behind the scenes of what goes on a report that we are just giving birth to today, but the true impact we’ll see hopefully be fulfilled over the next month, six months, year, two years as we get out and tell people about it. Thank you so much, both of you. I appreciate it.

Dr. Gail Wilens…:         I appreciate.

Senator Bill Fr…:           Thank you.

Chris Jennings:             Thank you Senator. Thank you for your leadership and your participation. We really appreciate it.

Senator Bill Fr…:           Thank you. So to close, where do we go from here? The goal of this three year initiative has been to find a package of pragmatic, forward-thinking policies to improve the healthcare system that all sides could agree to in today’s polarized political environment. The 10 members of our initiative in coordination with the Bipartisan Policy Center will advocate strongly for these proposals on Capitol Hill and with the administration. We recognize that substantive action, particularly on an issue as complex and polarizing as healthcare is always tough, difficult in an election year, but it is clear that healthcare costs continue to be a top issue for voters. We will work to pass what is possible in the short term such as surprise medical bills and addressing prescription drug prices while laying the groundwork for greater action in 2021.

Senator Bill Fr…:           This episode of A Second Opinion was produced by Todd Schlosser, the modus creative group team and snapshot interactive. You can subscribe to A Second Opinion on Apple podcasts or wherever you are listening right now and be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about this show, it’s guest and sponsors at secondopinionpodcast.com. Thank you for joining us for A Second Opinion, engaging at the intersection of policy, medicine, and innovation.