Less than two weeks before the historic 2018 election, the Nashville Health Care Council hosted a dynamic discussion with nationally known policy experts, offering insights on the state of health care policy. The panel included former Senate Majority Leader Tom Daschle, founder and CEO, The Daschle Group; former Senate Majority Leader Bill Frist, M.D., partner, Cressey & Company; Sheila Burke, chair, government relations and public policy, Baker, Donelson, Bearman, Caldwell & Berkowitz and former executive dean, Harvard Kennedy School; and Doug Holtz-Eakin, president, American Action Forum.

Susan Dentzer, president and CEO, Network for Excellence in Health Innovation, moderated the discussion, which covered a wide range of topics, including forecasts for the election, the future of the Affordable Care Act, prospects for bipartisan efforts and the importance of social determinants of health.

Dentzer began the program by pointing out that health care is the top issue concerning voters as they turn to the polls. Both Democrats and Republicans agree that health care costs need to be addressed, but that is perhaps as far as the consensus goes.

Less than a week ago, President Donald Trump proposed regulations that would lower prices that Medicare pays for certain drugs based on the prices paid in other advanced industrial countries - a huge change with the potential to save money for the government and beneficiaries, but with an uphill battle to fight in implementation.

"There is a growing sense and concern about cost, as there has been for some time. Pharmaceutical costs have received the most attention as of late. For a long time, it was insurance companies, then hospitals. There is always someone to blame," Burkesaid. "But more than ever, there are confusion and anger over high prices. The White House's announcement this week about regulating drug pricing caters to this issue that is being raised in every community. But the solutions are much more complicated."

Senator Frist predicted that Democrats will win majority in the House of Representatives and "pick up a couple of Senate seats." The maneuvering by the White House now, he says, is not about the 2018 election but about the 2020 presidential election. He pointed out that midterm elections are known for low voter turnout, so it's all about motivating the bases to vote.

Holtz-Eakin agreed: "President Trump has alienated Democrats, Independents and some Republicans, so now it's all about catering to the base. What activates the bases? For Republicans, it's Medicare for All. For Democrats, it's pre-existing conditions."

Despite the current environment of partisan discord, the speakers pointed out some areas of health care that could see bipartisan support.

"In fact, there is a lot of interest in 'second tier' issues, not that they are secondary in importance," said Senator Daschle. "There is overwhelming bipartisan support for community health centers, transparency and social determinants of health. Another area that the administration is working on that is vitally important to both sides is bio defense. Over the past 100 years, we have lost more people to disease epidemics than in wars. But we are not prepared for the next one."

The topic of social determinants of health was woven throughout the discussion, as it has become common knowledge that these factors have a huge impact on population health and the cost of care.

"Health care is local, and communities need to come together to address these issues and put efforts in place to move the needle collectively, engaging resources to address things like healthy eating, transportation, housing, smoking, etc.," said Senator Frist, who also leads NashvilleHealth, a community initiative dedicated to improving the health and well-being of all Nashvillians.

With the panel taking place in Nashville, an international center of health care expertise, speakers encouraged those in the audience to engage in Washington, D.C., as much as possible to make their views known.

"I can't tell you how important the input from Nashville's health care leaders is right now," said Senator Daschle. "Look at government as a private-public partnership. Private-sector experts need to be at the table to make meaningful change in health care policy."

"Nashville is known for fantastic innovation, and that voice should be heard in Washington so it can continue," Holtz-Eakin said. "This community is producing an enormous amount of data, which should be used to inform and spur thought leadership."

A final word of advice from the panel: "Vote," Burke said. "Only about 30 to 40 percent of the eligible population votes in the midterms. I can't overestimate how important it is to be engaged in this and all elections."

The presenting sponsor for the program was BlueCross BlueShield of Tennessee. Supporting sponsors were Bass, Berry & Sims, Cressey & Company, KPMG, and LifePoint Health.