Terry H. Schwadron
Dec. 16, 2019
Republicans in Congress and right up to Donald Trump keep saying they want to reduce prescription drug prices.
Now House Democrats have delivered on a legislative vehicle to do so, passing a bill along virtual party lines, 230–192. The Senate majority Republicans already are signaling that the bill is dead on arrival in their chamber.
Public concern among voters for action on rising prescription drug prices is a political as well as medical headache, and it won’t go away easily with an aspirin, even an overpriced one.
So, despite all the campaign promises, despite the mock horror during impeachment hearings that Democrats were ignoring prescription drug pricing for efforts to oust Trump from office, perhaps we should conclude that Republicans don’t want to create substantial price changes for prescription drugs.
Here’s the upshot: The bill, HR 3 renamed the Elijah E. Cummings Lower Drug Costs Now Act, would allow — or require — the government to negotiate lower prices for up to 250 prescription drugs supported through Medicare. Advocates say it would save the government $456 billion between 2020 and 2029, and result in eight fewer new drugs coming to market over the next decade that Democrats argue are simply copies of existing drugs rather than new ones. It also says the affected drugs should be indexed against a set of international costs to lower prices for American consumers.
The Congressional Budget Office found that the bill also would lower health insurance costs for employers and increase federal revenue by about $45 billion because employer insurance premiums would decline, and those savings would manifest in increased taxable wages.
The Republican argument is that this approach is creating price controls, a practice they oppose as stifling investment by Big Pharma in new drugs. Some Republicans favor an approach by Senators Chuck Grassley, R-IA, and R-Iowa) and Ron Wyden, D-OR, that would cap price increases in Medicare to the rate of inflation and limit seniors’ out-of-pocket costs.
Some progressives criticize HR3 because it does not go far enough. They take the Bernie Sanders-approach here and say that all drugs should be indexed against a set of international costs to lower prices for American consumers.
Donald Trump has at one time or another taken each of the positions, but generally now defers to Senate Majority Leader Mitch McConnell, who basically wants an approach that does not split his Republican majority.
Like every other issue, prescription drug prices is something to be examined through a political lens. Passing this bill gives Democrats yet another legislative would-be achievement to parade among home-district voters besides impeachment — just as passing the USMCA updated trade agreement with Mexico and Canada and child-care leave for federal employees.
But this one already has landed with a thud on McConnell’s Senate desk, where all good ideas go to die as an actual solution.
Of course, the prescription bill will have a new life as a campaign plank for Democrats to maintain their House seats. The Democratic Congressional Campaign Committee already has said it plans to target ads to voters in swing districts and those currently held by vulnerable Republicans after the vote. And, of course, to highlight that this is a Trump promise not kept.
We probably can also view the bill as a marker for how Democrats would address rising prescription drug prices if they were to gain control of the White House and Congress. The drug companies have heard the message, and are marshalling bigtime lobbying efforts to squash the approach for damaging investments beyond the first years.
Trump’s representatives have worked with Speaker Nancy Pelosi’s office toward a prescription bill, offending Congressional Republicans, but Trump has backed off support in favor of the Grassley-Wyden bill in the Senate. But that bill is not going anywhere either, because other Republicans say it reflects a price-control attitude.
Under the bill, any negotiated prices would be available to those covered by private insurance as well as Medicare.
Days ahead of Thursday’s vote, they introduced their own drug pricing proposal, which Pelosi and Democrats dismissed as too incremental.
Democrats took control of the House in 2018 by campaigning heavily on health care, and members want to repeat that success as they seek to keep control of the House and win the Senate in 2020. The bill also gives moderate Democrats in Congress a chance to tout a health care issue that’s separate from the “Medicare for All” debate that has become part of the Democratic presidential primary.
In 2016, Trump campaigned for just such an approach, saying,“When it comes time to negotiate the cost of drugs, we are going to negotiate like crazy.”
For all the talk in both parties about the high cost of health care, the arguments to date have been about paying for insurance or about whether the resulting systems are robust enough to support patients with pre-existing conditions. Somewhere, somehow, the parties are going to need to come to grips with the fact that government will have to act on the actual rising health prices for drugs and services.
If this week is a model, that path is just another continuation of the Great Divide.