2018 midterms

Drug Costs Are Too High, But Trump’s Proposal Was Primarily About the Midterms

Trump unveils his plan at the Department of Health and Human Services on October 25, 2018. Photo: NICHOLAS KAMM/AFP/Getty Images

Donald Trump may be trying to direct voters’ attention to a migrant caravan in Central America, but he also knows it’s a health-care election. On Thursday, the president announced a plan to bring down drug costs for Medicare. The government intends to create an international pricing index, which would, the New York Times reported, use “foreign drug prices as a reference or benchmark to judge prices in the United States.” The idea isn’t new, but it hasn’t received much political traction, largely because drug companies themselves vehemently oppose it — and have the money to make sure Congress heavily weights their concerns. Other portions of the proposal, which is the result of a drafting process HHS began earlier this year, would allow vendors to negotiate prices for certain medications covered under Medicare Part B. “Not all drugs would be included in this test. CMS would focus on drugs made by just one company (which tend to be expensive) and biologic medicines, which make up a large share of Medicare Part B spending,” Politico reported. The proposal would also allow HHS officials to charge a flat incentive fee for doctors who prescribe certain medications; currently, doctors can receive higher fees for more expensive drugs.

The president is certainly right one about one thing: Drug prices are too damn high. But Trump’s rhetoric on drug pricing sounds awfully similar to the rest of his nationalist message, and as a result, he fails to really address the problem he wants to solve. “Americans pay more so that other countries can pay less, very simple, that’s exactly what it is,” he said. “It’s wrong, it’s unfair, it’s not surprising where it’s far more costly to us than even this and we’re changing them also.”

This isn’t the first time Trump has blamed high drug prices on “global freeloaders,” and while there’s some evidence that they are “free-riding,” as one economist put it to Vox, Trump’s rhetoric ultimately amounts to misdirection. American pharmaceutical companies charge obscene amounts for drugs like insulin because they can get away with it. Prices are lower in other countries because those nations have structures in place that allow them to negotiate prices. If you’re upset about high drug prices, blame America’s commitment to a relatively unrestrained free market, not, say, the policies of the U.K.

Thursday’s proposal is the latest in a series of Trump attempts to polish his party’s health-care image. An HHS proposal to force pharmaceutical ads on television to list the prices of drugs that cost more than $35 for a 30-day supply probably wouldn’t cause any harm, but there isn’t a lot of evidence that it would do much good, either. If a patient needs a specific drug, they need a specific drug; knowing the drug’s price changes nothing about their material circumstance. Another recent Trump policy appears more substantive: He signed a bill that bans gag clauses for pharmacists, which prohibit them from telling patients that a less expensive version of the drug is available.

Right now, Trump’s plan for cutting drug costs is just a proposal. As Politico explained, it still has to go through a federal rulemaking process, so even if the administration’s policies are sound their consequences won’t be felt for a while. Trump’s announcement feels like a distraction at most — which is exactly what Republicans need. In multiple midterm races, Republican incumbents have denied claims that they oppose protections for people with preexisting conditions. But it will be difficult for the party to escape its own health-care record. Since the Affordable Care Act came into effect, Republicans have been determined to strip away the law’s most progressive proposals. The Justice Department has refused to defend the ACA’s preexisting conditions protections against a lawsuit filed by 20 Republican state attorneys general. Had Republicans been able to enact the American Health Care Act in 2017, poor Americans would have borne the brunt of the costs; the version of AHCA passed by the House would have cut $880 billion from Medicaid. Trump himself called the bill “mean,” but not before he’d spent weeks defending it from criticism.

2018 is the health-care midterm for a reason: Donald Trump and the rest of his party spent the last two years trying to advance policies that would deprive the most vulnerable Americans of access to health care. And as Politico notes, it appears most voters didn’t even hear about the president’s cost-cutting promises. Trump can complain about high drug prices all he wants. But for many voters, the health-care moment they remember on November 6 will likely be the celebratory beers House Republicans brought into the Capitol after they voted for AHCA.

Drug Costs Are Too High, But Trump’s Plan Was About Midterms