Drug shortages in the U.S. have hit a record high and lawmakers warn they could mean life or death for millions of patients.

A House committee is investigating what Congress can do to the supply chain to make sure doctors don’t have to keep rationing essential drugs like cancer treatments. Health experts agree the shortages of hundreds of generic drugs need urgent attention.

But they’re still trying to build consensus on a remedy. “The market does not reward reliability,” said Dr. Marta Wosinska, of the Brookings Institution.

She told lawmakers Tuesday the federal government only offers incentives to pharmacies and providers for buying the cheapest generic drugs not the best.

“If we want resilience, we will have to pay for it one way or the other.” But Idaho Senator Mike Crapo expressed concern about how those decisions would be made.

“Do we want to have a federal government agency evaluate every generic provider and decide? I personally have a little bit of trouble with that.”

Wosinska said the FDA is currently developing an evaluation system for drug manufacturing practices. “We still don’t know whether the program would stand up and the metrics would stand up and would do exactly what we want them to do.”