After railing at the injustices of U.S. health care for decades, Sen. Bernie Sanders in January became the new chairman of the Senate Health, Education, Labor & Pensions Committee. The job gives the health care industry\u2019s biggest Washington nemesis an unprecedented opportunity to shape health care reform in Congress. But the sort of radical changes he seeks could prove elusive. Even Sanders concedes there are limits to the powers of his position.<\/p>\n

President Joe Biden\u2019s State of the Union address Tuesday night showed how much of Sanders\u2019 platform has moved into the mainstream of the Democratic Party, with Biden at times sounding like his former Democratic primary foe, lashing out at Big Pharma and its \u201crecord profits.\u201d Biden bragged about measures taken to lower drug prices and halt surprise bills during his term thus far, and he urged Congress to pass a federal expansion of Medicaid.<\/p>\n

Still, the radical changes Sanders seeks could prove elusive. During an interview with KHN at his Senate office recently, the independent from Vermont spoke about the prospects for lowering drug prices, expanding access to primary care, and his ultimate goal of \u201cMedicare for All.\u201d<\/p>\n

The interview has been edited for length and clarity.<\/p>\n

Q: What do you hope to achieve as chair of the HELP Committee \u2014 in terms of legislation, but also messaging and investigations?<\/strong><\/p>\n

What I ultimately would like to accomplish is not going to happen right now. We have Republicans controlling the House. And many of the views that I hold, including Medicare for All \u2014 I think if we had a vote tomorrow, we\u2019d get 15 to 20 votes in the Senate and would not win in the House. I realize that. But I happen to believe our current health care system is dysfunctional.<\/p>\n

We spend twice as much per capita on health care as other countries and 85 million people have no insurance or are underinsured. It is a dysfunctional system that to my mind needs to be fundamentally changed to a Medicare for All system \u2014 but we ain\u2019t gonna get it.<\/p>\n

Q: What can you actually accomplish?<\/strong><\/p>\n

[From] a poll a couple of months ago just among Republicans. Top concern? High cost of prescription drugs. We\u2019re long overdue to take on, in a very bold way, the greed and outrageous behavior of the pharmaceutical industry.<\/p>\n

Q: There are so many parts of the system that are messed up \u2014 patents, 340B, pharmacy benefit managers, insurance issues with formularies \u2026<\/strong><\/p>\n

Right, there are a million parts to this problem.<\/p>\n

Q: So short of a complete overhaul, what are the parts that you think you can change?<\/strong><\/p>\n

Every year the U.S. government through [the National Institutes of Health] spends tens of billions of dollars on research. The Moderna vaccine was co-developed between Moderna and NIH and received billions of dollars in assistance, guaranteed sales, and you know what\u2019s happened in the last couple of years. The CEO of Moderna 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 was highly supported by taxpayers of this country. And that\u2019s one example of many.<\/p>\n

What is the responsibility of a drug company that receives very significant support \u2014 financial support, intellectual support for research and development \u2014 to the consumers of this country? Right now, it is zero. \u201cThank you very much for your support. I will charge you any price I choose.\u201d We have to end that.<\/p>\n

That\u2019s the starting point.<\/p>\n

Q: But what\u2019s the mechanism? \u201cMarch-in\u201d rights, whereby the government could force a company to share its license for a drug that was developed with federal investment, allowing others to produce it?<\/strong><\/p>\n

That is one approach. Threatened by people in George W. Bush\u2019s administration, by the way. March-in is one option.<\/p>\n

Reasonable pricing is another area. I have made two trips to Canada: once as a congressman from Vermont, took a bunch of working-class women across the border to buy a breast cancer drug; once as a presidential candidate, took people from the Midwest, and we bought insulin. The price was one-tenth of the U.S. cost in both cases.<\/p>\n

Another area is primary health care. I have worked hard with other members through the Affordable Care Act and American Rescue Plan [Act] to significantly expand community health centers. FQHCs [federally qualified health centers] provide primary care, dental care, mental health counseling, and low-cost prescription drugs. About one-third of [people in Vermont] get primary care through community health centers.<\/p>\n

Q: I was at a meeting of FDA and patent office people, hearing from biosimilars companies, patients, etc., and a lot of what they were <\/strong>saying is that the U.S. Patent and Trademark Office can\u2019t do that much about patent thickets,<\/strong> and it\u2019d be good if Congress did something.<\/strong><\/p>\n

That is one of the disgraceful tools that pharma utilizes to make sure we pay high prices and don\u2019t get generics. Yes, it\u2019s certainly something that we should be looking at.<\/p>\n

Q: Other priorities?<\/strong><\/p>\n

The crisis in the health care workforce. We don\u2019t have enough doctors, nurses, dentists, mental health counselors, pharmacists. The nursing crisis is enormous. We have a hospital in Burlington, moderate size by national standards, largest by far in Vermont. They told me they are going to spend $125 million on traveling nurses this year. One moderate-sized hospital! Meanwhile we have young people who want to become nurses, and we can\u2019t educate them. We don\u2019t have enough nurse educators. I think we get bipartisan support for that issue.<\/p>\n

Another thing I want to look at is dental care. Not enough dentists, too expensive, whole regions don\u2019t have them.<\/p>\n

Q: Did you agree with President Biden\u2019s decision to end the public health emergency in May?<\/strong><\/p>\n

[Frowns] I have some concerns.\u00a0[Sanders appeared to be the only member of Congress wearing a mask during Biden\u2019s speech on Tuesday.] It\u2019s going to dump a lot more people into the uninsured again.\u00a0<\/p>\n

Q: And things like vaccines would not be covered anymore.<\/strong><\/p>\n

They\u2019d go on the market. Our friends at Pfizer and Moderna want to quadruple the prices. So if you\u2019re hesitant now about getting vaccinated, and it\u2019s free, what about when it costs you $125?<\/p>\n

Q: As you say, drug prices are a big concern for everyone. But among Republicans there seems to be more inclination to push on pharmacy benefit managers, or PBMs, as opposed to drug companies. Is that an area where there could be legislation?<\/strong><\/p>\n

You\u2019ve got the insurance companies, the PBMs, and pharma. Everyone wants to blame the other guy. And yet they\u2019re all culpable. And we\u2019re going to take a hard look at it.<\/p>\n

Q: Is Dr. Robert Califf, the FDA commissioner, a good interlocutor for you?<\/strong><\/p>\n

A lot of work has to be done with FDA. Let\u2019s just say I think it\u2019s important that we take a hard look at what they\u2019re doing. They have some responsibility for pricing. It\u2019s part of that mission that they haven\u2019t exercised.<\/p>\n

Q: What about the 340B issue? Accusations that hospitals are gaming the system.<\/strong><\/p>\n

Yes, it is something. One of the first things [I did] when I was mayor of Burlington from 1981-89 was take away the tax-exempt status of the hospital. Because I did not believe they were fulfilling their responsibility to serve the poor and working families. We had a lot of discussions, and the situation improved. Right now the criteria to receive tax-exempt status is extremely nebulous. That\u2019s an issue somewhere down the road I want to look at. If you\u2019re not going to pay taxes, what are you, in fact, doing?<\/p>\n

Q: Do you have particular allies in either party?<\/strong><\/p>\n

I talked today with a conservative GOP senator who will work with me on issue X, but not issue Y. It depends on the issue. If we\u2019re going to be successful, we\u2019re going to need bipartisan support. And there is that level of support. I\u2019ve talked to now four out of the 10 or 11 Republicans on the committee, and I\u2019ll talk to the rest.<\/p>\n

Q: Do you have a policy for dealing with the lobbyists?<\/strong><\/p>\n

I don\u2019t have lobbyists flooding through my door. These lobbyists are effective, well paid, and they help shape the culture of where you\u2019re going. My culture is shaped by going out and talking to ordinary people. I\u2019ve talked to too many elderly people who cut their prescription drugs in half.<\/p>\n

I\u2019m not worried about the lobbyists. Worry about the people who are dying because they can\u2019t afford prescription drugs.<\/p>\n

I don\u2019t have to have some guy who makes seven figures a year telling me about problems of the drug companies. They have to explain to American people why they made $80 billion last year and people can\u2019t afford medicine.<\/p>\n

Q: Are you going to bring in pharma executives for hearings?<\/strong><\/p>\n

We\u2019re looking at all options.<\/p>\n