HLTH 2022: Federal COVID response slowed by absence of unified public health system, says Becerra

America’s response to COVID-19 has been hampered by the lack of a national public health system, according to U.S. Department of Health and Human Services Secretary Xavier Becerra.

Speaking at the 2022 HLTH conference, Becerra drew a distinction between the “public health system that is nationwide” the nation now has, and a “national public health system.” With the latter, he said, the person occupying his office would be able during a pandemic to obtain health data quickly from everywhere in the country in order to address the crisis.

“But in our system of public health, we have to beg the 50 states, the territories, the Indian tribal governments, to give us data we need to save lives, because they’re not obligated to. It’s unfortunate, and COVID really exposed it,” Becerra said.

Becerra made his remarks as part of a “fireside chat” where he was interviewed on a range of subjects by Ezekiel J. Emanuel, MD, PhD, professor and vice president for global initiatives at the University of Pennsylvania’s Perelman School of Medicine and a venture partner at Oak HC/FT.

Responding to a question about the legislation enabling Medicare to negotiate drug prices with pharmaceutical companies, Becerra said in 2023 the Centers for Medicare and Medicaid Services will decide which drugs it wants to focus on and begin negotiations with the manufacturers. The new prices will start taking effect in 2026.

Asked whether CMS would focus more on payment reform in the coming years, Becerra maintained the agency has been seeking alternatives to fee-for-service medicine, but that payers and other industry stakeholders have been aggressive in defending the present system.

“Every time we try to do something in that area we face a lot of litigation, or we face Congress responding to pushback from industry,” he said. He cited the example of lawsuits trying to stop CMS from implanting regulations to eliminate surprise billing, a relatively non-controversial issue.

“The difficulty is we can’t move as quickly as the private sector in a lot of things because we have to follow rules that have been set by Congress or by the courts,” he said, adding that opponets often accuse CMS of being “arbitrary and capricious” whenever it tries to implement change of any kind.

Challenged by Emanuel on the lack of federal research on long COVID, Becerra said, “We want to make sure we don’t leave communities out. Typically with research we go to those folks who are easiest to reach and get tested, and that often leaves out a lot of communities of color and low income. So finding those communities that may never have been approached for clinical trials slows us down.”

He added that Congress has not appropriated enough money for the agency to conduct the research needed to understand the causes of, and find cures for, long COVID.