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Ryan Cooper on the drug pricing debacle
It's too easy for corporations to derail democracy.
Hello everyone, I'm Ryan Cooper filling in for Libby for a moment. In case you don't know — I'm a daily columnist for The Week, so in terms of political writing I'm like a short order chef hired to cook up gallo pinto by the soup tureen for firefighters battling one of the big California blazes. The food might be somewhat bland, but the portions are large, and more importantly, piping hot.
On the subject of the Sick Note project here, my attention must turn to the ongoing dispute over the Democrats' reconciliation bill. One of several points of contention has to do with drug prices. Since well before 2018 the party has been promising to do something about the ridiculously inflated prices Americans pay for all their routine medications. The most obvious step to take is to allow Medicare to negotiate the prices it pays to drug companies, which is currently not allowed thanks to how Medicare Part D (the drug benefit) was set up by the Bush administration in 2003.
Yet now a handful of congressional Democrats have moved to block this comparatively modest proposal. Senator Kyrsten Sinema (D-Hot Topic) recent announced that she doesn't support this idea, and not even in a pared-back version that limits the number of drugs Medicare could negotiate on. In this she joins Reps. Kathleen Rice, Scott Peters, and Kurt Schrader, who blocked the drug price reform bill from getting out of the House Energy and Commerce Committee.
It's at times like these when the type of government the United States really has swims into focus. If you believe the Federalist Papers, the Constitution, every high school civics textbook, Schoolhouse Rock, and so on, the point of the American republic system is to allow for self-government that protects the citizenry from overweening government authority. "Separation of powers" is supposed to guard against any politician obtaining authoritarian power. The authority of the federal government is carefully delimited in the main body of the Constitution, and most of the Bill of Rights have to do with further restricting the power of the state.
James Madison, Thomas Jefferson, and all the rest of the inebriate slave-owning Founding Fathers were neurotically obsessed with protecting the people from repressive government. But it barely occurred to them whether the people might need rigorous protection from not enough government — perhaps because the character of the country in which they lived was much, much closer to how Romans lived in 100 B.C. than America even one century after the Constitution was ratified. Ulysses S. Grant noted this in his memoirs, written in 1885:
At the time of the framing of our constitution the only physical forces that had been subdued and made to serve man and do his labor, were the currents in the streams and in the air we breathe. Rude machinery, propelled by water power, had been invented; sails to propel ships upon the waters had been set to catch the passing breeze—but the application of stream to propel vessels against both wind and current, and machinery to do all manner of work had not been thought of. The instantaneous transmission of messages around the world by means of electricity would probably at that day have been attributed to witchcraft or a league with the Devil.
One could imagine, as Jefferson did, a Roman Republic-style nation of yeoman farmers that could function under a 1787-style system. Whether that applies to any period of American history is open for debate. Whether it could possibly work today is not. An advanced industrial nation simply cannot function without regular policy changes and an elaborate structure of state regulation. Disprove night watchman libertarianism with the following sentence: "Name me a rich country with a tax level below 20 percent of GDP."
The sole function all the vaunted "checks and balances" serve today is to make it exceptionally easy for any interested party to strangle the process of government. The pricing of drugs in this country is corrupt to a degree that would make your average tinpot dictator shift uncomfortably in his gold-plated throne — surely it is too much to allow abject money-grubbing sociopaths to jack up the prices of basic medication like insulin or epinephrine by hundreds or thousands of percent, thus causing blatantly avoidable deaths? Surely a study demonstrating that Americans spend more than twice what the French do on prescription drugs, and more than three times what the Dutch spend, risks politically destabilizing unrest?
A ruthless dictator might have an accurate enough perception of the fragility of his power, and the value of a quiescent population, to keep drug price-gouging within certain limits. The titanic self-regard and duplicity of American politicians immunizes them from such considerations. Sinema, Rice, Peters, and Schrader all campaigned on drug price reform, along with the rest of their party. Allowing Medicare to negotiate drug prices polls at 88 percent approval — probably the most popular policy that could possibly be assembled at this moment in history. It even substantially cuts government spending, the thing that moderates say they want more than anything. And yet the drug companies spread around a few bribes, and that was all it took for these corrupt swine to backtrack on half a decade of promises — because of campaign contributions and because they know lucrative lobbying and consulting gigs are waiting for them if they prove their fealty to the top 1 percent.
Meanwhile, the staggering sclerosis of American government provides innumerable opportunities for lobbyists to slide a stiletto blade between the ribs of any policy that might slightly reduce the profits of ruthless oligarchs who already have more wealth than anyone could ever spend. Once something has made it through the gauntlet of committees in both the House and Senate, the filibuster, full votes in both chambers, conference negotiations, obtaining the president's signature, and then a gauntlet of lawsuits baiting the reactionary rule-by-decree Supreme Court, it's virtually a miracle if a single person is helped at all.
The Italian philosopher Benedetto Croce coined the term "onagrocracy" to describe Italian fascism — "government by braying asses." Watching the Democratic Big Pharma toadies bought over the counter like a discount honey-baked ham ineptly dissemble about how they do too support drug price reform, just not in this particular format (the only one that has the remotest chance to be able to pass in the next decade, that is) puts me in mind of that phrase. As Eric Hobsbawm wrote in his autobiography: "Forced into the straitjacket of an 18th-century constitution reinforced by two centuries of talmudic exegesis by the lawyers, the theologians of the republic, the institutions of the USA are far more frozen into immobility than those of almost all other states."
All that said, to finish on an optimistic note, I highly recommend reading this post by Matt Bruenig about how Danish labor unions dealt with McDonald's when that company refused to abide by Denmark's labor system. In essence, sympathy strikes completely throttled the company until it was forced to behave. While Danish labor power ensured that the state did not sic the army on the workers, all this happened outside formal state structures — both an actual example of separation of powers, and an instructive lesson in what organized labor can achieve if sufficiently coordinated and disciplined.
Drug price reform still might pass if Americans kick up enough fuss to help the large majority of their party that wants to accomplish something on this issue. Similarly, the American Constitution may be 200 years out of date, failing to work as designed, and underpinning a fantastically corrupt state, but formal rules are not the end of politics. If you can, organize your workplace.