And even this study is just looking at a representative sampling, not the full scope of the problem. AARP’s Public Policy Institute last year tracked the retail prices of hundreds of brand-name drugs commonly prescribed to older Americans and found that more than 200 of them increased in price beyond the rate of inflation in 2017.

One might argue, in response, that a sensible executive branch would understand that lowering drug prices would be politically advantageous. And this insight, in turn, might lead some hypothetical Republican secretary of Health and Human Services to vigorously negotiate the prices of considerably more than the 25 drugs mandated by law. Alas, we must again remind any readers given to policy transports driven by logic and sound political calculation that the current, non-hypothetical HHS secretary is a former pharmaceutical industry executive. We must also gingerly remind said readers that all available evidence from the last 40 or so years of hard-right governance in Washington shows that Republicans will always place industry profits above their constituents’ needs. In short, the Republicans who currently have power in the White House and the U.S. Senate have not actually done any of the obvious things they could do to reduce drug prices, and can reliably be expected to stay the course, as they like to say.

Yet the Democratic speaker of the House is blithely proceeding as though none of these obvious and crushing truths have any purchase in the debate over health care policy. The Pelosi proposal doesn’t even seem to have any safeguards in place to prevent HHS from “negotiating” pharma-friendly high prices (which, again, is easy to imagine any Republican administration, and especially this Republican administration, doing). And in the event of a stalemate over prices, the negotiations only get sent to GAO (which has no experience regulating markets of any kind) if the pharma company in question and government regulators can’t come to an accord over a modified price.* The government is thus free to continue doing nothing in the far more likely scenario of both parties showing that they can agree on an exorbitant one.



This is all evidence of a fundamentally broken congressional Democratic policy apparatus. If one were to try to come up with a plan that both has some real chance of getting signed into law and that would make any meaningful difference in the lives of voters, it would not look anything like this. The process broke down right after the part about it having a shot at becoming law, and even that step doesn’t seem to have been thought through. After all, Pelosi unveiled this proposal in the midst of a fight with the administration over congressional oversight—and sure enough, the president said the next day that he wouldn’t do any drug prices deal until and unless the House stops investigating him.

