Democrats negotiate over whether to shoot themselves in the foot

Democrats negotiate over whether to shoot themselves in the foot

Opinion by Paul Waldman

Columnist

Today at 4:02 p.m. EDT

There’s an eternal debate in Washington about how much policy matters to politics, one that reemerges in slightly different forms. Does passing a bill with popular provisions really help you win elections? Do you get punished for passing something unpopular? Does the detailed substance of policies matter, or is the political battle over them just a contest of spin?

But here’s a pointed question Democrats might consider: What if you promise you’re going to do something incredibly popular, then spend months touting it as evidence of how you’re going to help people, and then drop it from the bill you pass?

That outcome is a very realistic possibility on the Build Back Better social infrastructure plan now being negotiated in Congress.

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Polls have shown that while Americans don’t really have a good grasp of what’s in the BBB bill, when you tell them, they like just about all of it, from paid family leave to universal pre-K to Medicare covering dental care. But what stands out in every poll as the most popular provision is allowing Medicare to negotiate lower prescription drug prices.

The Kaiser Family Foundation just released a new poll that goes into detail on this question, and the findings are striking:

83 percent of Americans favor “allowing the federal government to negotiate with drug companies to get a lower price on prescription drugs for people with Medicare and private insurance.” That includes 95 percent of Democrats, 82 percent of independents and 71 percent of Republicans.

When presented with arguments in favor of negotiation (“Americans pay higher prices than people in other countries, many can’t afford their prescriptions, and drug company profits are too high”) and opposed to it (“it would have the government too involved and will lead to fewer new drugs being available in the future”), 84 percent found the positive argument convincing. Only 33 percent found the negative argument convincing.

After hearing those arguments, the number of people favoring negotiation remained unchanged, though many Republicans moved from “strongly favoring” negotiation to “somewhat favoring” it.

By an extraordinary 93 percent to 6 percent, Americans rejected the pharmaceutical companies’ argument that they need to charge high prices to fund innovative research, instead agreeing that even if prices were lower the companies would still have plenty of money to fund that research.

If there was ever a political home run of a policy change, this would appear to be it.

Right now, Medicare is barred by law from negotiating, which is a key reason Americans pay the highest drug prices in the world. The negotiation provision in the bill would have two effects: It would bring down the prices, and the savings that would produce could then be used to fund other parts of the bill.

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The money involved is enormous; according to a recent Rand Corp. study, setting U.S. prices at 120 percent of what governments pay in a group of our peer countries (one of the proposals that has been made) on just 50 top drugs would save the country $83.5 billion a year — or a trillion dollars in savings after 12 years. A Congressional Budget Office analysis in 2019 said the government could save $456 billion over 10 years by having Medicare negotiate prices.

Unfortunately, that also makes it a tempting target for the Democratic centrists who want to slash away at the bill: If the negotiation provision is jettisoned, that means there’s less money to fund the social infrastructure provisions they don’t like.

There is a huge lobbying fight going on right now, with the enormously powerful drug companies pitted against the enormously powerful AARP, which supports price negotiation. The companies have some centrist House Democrats on their side, and Sen. Kyrsten Sinema (D-Ariz.) has also made clear that she opposes price negotiation, though Sen. Joe Manchin III (D-W.Va.) supports it.

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But it’s one thing to say you don’t like a particular provision, and another to threaten to kill the entire bill if it’s included. After all, everyone has to compromise here.

Right now no one knows whether price negotiation will make it into the final bill. Members are exploring different ways to scale the proposal back that might meet with the approval of the centrists and drug industry allies.

But if it does fall by the wayside, every Democrat will suffer. It’s not just that reducing the price of medicines is absurdly popular. It’s also that Democrats have promised this over and over. If the bill passes without it, a lot of voters are going to decide that Democrats failed them, all the other things the bill does notwithstanding.

And they won’t be wrong.