The most intense fights in American politics center around questions of redistribution — at what levels should the government tax the rich, and how generously should it subsidize the poor and sick? The debates tend to run along familiar tropes — big government, free markets, personal responsibility, and so on. But the best insight into these fissures comes by looking at their opposite: What about those cases when big government is not the source of partisan discord?
This weekend, the Washington Post ran two long stories about cases like this. One explained the persistence of massive subsidies for sugar growers. Another reported on Medicare’s astonishing inability to stop drug-makers from foisting a massively expensive drug on patients, rather than using a cheaper, equally effective alternative. Both articles reveal, through contradistinction, the real ideological source of the partisan divide.
The drug story explains how Medicare spends more than $1 billion a year reimbursing doctors who prescribe Lucentis, at $2,000 a dose, rather than Avastin, which costs $50 a dose, and which studies show works just as well. The story explains how Genentech has outmaneuvered the federal government, preventing it from requiring Medicare to reimburse Avastin instead. The reasons for this vast waste of taxpayer money are at once boring and infuriating, but they boil down to rules preventing the federal government from managing its Medicare dollars wisely. Here is a crucial passage:
The Medicare agency is blocked from seeking better drug prices by negotiating directly with the drug companies, as health agencies in other countries do. Authorities in Britain, for example, have negotiated a price of about $1,100 per dose of Lucentis, and in the Netherlands a dose sells for about $1,300.
A spokesperson from the drug lobby proceeds to explain that, if the government refused to waste its Medicare spending, it would amount to “price controls.” That has also been the Republican line. They do have a preferred alternative: encouraging patients to pinch their own medical pennies. That can certainly work in some cases. But patients are often helpless before the recommendations of their doctors, and the Post lays out a case that makes depressingly clear the imbalance of power and information between the average patient and a drug company that has far more skin in the game than a Medicare patient sprawled out on a doctor’s bed could ever muster.
When the Bush administration passed Medicare Part D, it fought off liberal amendments that would have let it save money by negotiating down the cost of the drugs it purchased. I wrote an article citing this, among other elements of the law, as evidence of the Bush administration’s solicitousness toward the drug industry. David Frum, still a Bush loyalist at the time, rebutted my complaint by accusing me of favoring “price controls.” And so the Post presents us with the necessary and intended result of this policy: a federal-government policy of wasting billions of dollars solely for private benefit.
Meanwhile, sugar subsidies are one of the oldest boondoggles in Washington, a combination of quotas limiting imports, price supports, and taxpayer-financed loans that boosts the price and profitability of the domestic sugar industry, which costs taxpayers more than a billion dollars a year. Despite lacking any public-policy merits whatsoever, the program survives with strong bipartisan support, ranging from Al Franken to Marco Rubio. The story ends on the comical note of quoting Florida Representative Ted Yoho, tea party maven and avowed enemy of big government, defending his strong advocacy of sugar subsidies: “I ran on limited government, fiscal responsibility and free enterprise, but when you’ve got programs that have been in place and it’s the accepted norm, to just go in there and stop it would be detrimental to our sugar growers.”
You hear that? Sugar subsidies are an accepted norm. If tea partiers believe anything, it’s that, once a government program has been in place, we can’t get rid of it. It would hurt sugar growers, Yoho proceeds to explain, by forcing them to sell their product in the free market on even terms. This is completely unlike programs such as Medicaid and food stamps, which Yoho wants to cut, because cutting them wouldn’t be detrimental to anybody. At least not anybody he cares about.
We should be perfectly clear about the fact that Democrats do not have clean hands here — especially not on sugar subsidies, where Democrats representing rural constituents happily shovel billions into the farm subsidy maw. But the Republican enthusiasm for wasteful domestic spending here is what’s especially telling, because it’s the Republican Party that has declared rhetorical war on government, and which is its entire weight behind a broad-based assault on Obamacare, food stamps, unemployment benefits, and the entire structure of government support for the disadvantaged.
Republicans insist that they have nothing against the poor and sick, that they merely want to restrain the federal budget and so on. Were that true, they might be starting their assault on government with those programs benefiting the richest constituencies, coming for the hungry and jobless only at the end. Instead, it’s the other way around: The only programs able to attract continuing Republican support are the ones whose only purpose is to enrich powerful interests. The kinds of government spending Republicans will happily support tells you what you need to know about the kinds of spending they won't.