Photo: Getty

Over the last couple of months, a battle has been playing out behind the scenes of the House Democratic caucus over the party’s plan to address staggering drug prices, in a depressing and predictable fashion.

Democratic leadership has been holding talks with the Trump administration, trying to strike a deal that can get passed; the Hill reports that drug prices are “a rare area of possible bipartisan agreement this year.” Earlier this year, two GOP senators introduced a bill that was described by Axios as something that “could have been written by Bernie Sanders,” which is kind of true—it would prevent drug companies from charging higher prices for drugs here than they charge in Canada, France, the U.K., Japan or Germany, and unlike the Trump administration proposal, it wasn’t just limited to pricing for Medicare part B drugs.

But Democratic leadership has focused on a plan that is much weaker. This might not be surprising, given that awful centrist Pelosi health policy aide Wendell Primus has been running talks, according to Politico, who reported in February that he was “searching for an approach that could both significantly lower drug prices and potentially win support from the Trump administration.”

That approach: Appointing a third-party arbitrator to set a price if the government and the drug companies can’t agree on a price. Politico reported that “the arbitration process would be voluntary and non-binding” and limited to a subset of high-price specialty drugs. In other words, toothless and nowhere near broad enough to help patients.

The major competing proposal comes from Democratic Rep. Lloyd Doggett. His bill, on the other hand, would allow Medicare to negotiate directly with drug companies and, if negotiations failed, authorize generic competitors to manufacture their drugs. This would hit drug manufacturers where it hurts—pharmaceutical companies gaming the patent system to keep generics off the market is a major way that they keep their prices so high.

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The Congressional Progressive Caucus endorsed Doggett’s bill earlier this week. “We urge Democratic leadership to give this important legislation equal consideration alongside all other prescription drug pricing proposals,” co-chairs Rep. Pramila Jayapal and Mark Pocan said in a statement. “Any bill that comes to the House floor must include a strong backstop and negotiation for all drugs to gain the full support of the CPC.”

Today, Politico Pro (paywalled) reports that progressive Dems who support the Doggett proposal were “bullish” after a meeting with health committee leaders yesterday, and that Reps. “Pallone and Neal appeared to have reassured the caucus that neither had settled on arbitration.” Indeed, Pocan told Politico that “if we did come to an arbitration model there would be a large womp womp that would happen. I think that message got across really well.” Surely, we would not want a large womp womp to happen.

Still, the article reports that Neal said he was not “wedded” to arbitration, which is not exactly encouraging; it’s a sad state of affairs if progressive members are excited and mollified just by being told their policy isn’t totally off the table.

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Which demonstrates how utterly insane the bounds of this debate are. Everybody knows that drug prices in the U.S. are unsustainable and appalling, and that voters are mad as hell about them. Unlike with Medicare for All, where Democratic leadership appears to (wrongly) fear moderate voters as much as the healthcare industry, the problem in this case is not the voters. Voters are not going to turn out to the polls mad as hell that their drug prices were cut. The problem is purely the pharmaceutical industry.

Just look at this Public Policy Polling data from swing districts, reported in another Politico Pro article this morning:

For example, 83 percent of voters polled in the Iowa district represented by Republican Steve King, said they would support ending a company’s monopoly on a drug and letting other manufacturers produce the product if the government determines the company abused its position and raised prices beyond a patient’s ability to pay. When broken down by 2016 election choices, 81 percent of those who voted for President Donald Trump supported the idea, compared to 88 percent of those who voted for Hillary Clinton.

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81 percent of Trump voters want the government to take away drug company monopolies that allow price-gouging. 83 percent in fucking Steve King’s district! 83 percent of people do not agree on anything in America. That’s putting up higher numbers than favorability for Dwayne “The Rock” Johnson, Jackie Chan, Will Smith, and Paul McCartney.

So this is plainly not a question of mollifying swing or even Republican voters. It is apparently a question of mollifying the pharmaceutical industry—more on that in a minute—and the Republican party, who is openly and completely wedded to doing whatever allows industry to squeeze the life and blood out of regular people for profit in total opposition to what their voters want, because they have successfully divorced their electoral successes from any kind of popular policy while Democrats have convinced themselves that voters don’t support progressive policies.

Democrats shouldn’t have any kind of voter backlash to fear to fear from the doing the right thing here, because no voter gives a shit about pharmaceutical companies or their profits. But they do have to fear two things: losing their access to pharma money for elections, and pharma giving to dark money conservative groups that then go after Democrats.

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The American Action Network, a dark money group that has spent tens of millions on elections to elect Republicans, has received millions from PhRMA, the trade group representing pharmaceutical companies in Washington with yearly revenues of almost half a billion dollars: They gave $4.5 million in 2010, $6 million in 2016, and $1.5 million in 2017. That’s in addition to millions sprinkled across other conservative electioneering groups.

Let’s pretend, for argument’s sake, that Democrats would be willing to jeopardize the money that the pharmaceutical industry donates to their candidates and campaigns. They would still have to fear PhRMA pouring more of their cash into Americans For Rich Bastards, Inc., which in turn would run ads about how Democratic candidates want to train ISIS as kindergarten teachers or whatever.

So is there some political risk for Democrats? Sure. But there’s going to be political risk in anything, even the most moderate proposal which threatens an iota of drug company profits, and the amount of credit you would get with voters for going before the people and saying, accurately and with a straight face, that you will ensure no American ever has to worry about paying for drugs again, is far greater. It would be, in fact, an immeasurable sea change for Democratic leadership to actually boldly support a genuinely transformative policy. (Not to mention, it would likely also help boost the small-donor fundraising that Democrats should be focusing on.)

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Voters want neither negotiation nor arbitration. They want to crush the drug companies, who are currently getting away with murder. Imagine having a political enemy as widely loathed as the pharmaceutical industry and wasting it this way.