By David Pring-Mill
The Trump administration’s recent language, on the topic of drug pricing, reveals a history of disingenuous ideology. Over the years, the Republican Party has aligned itself with proponents of laissez-faire capitalism. And yet, along with its gerrymandered counterpart, the party bails out banks and big businesses, routinely doles out subsidies, overlooks price-fixing by big pharma, and is reluctant to deviate from existing frameworks.
Many of the party’s corporate donors seem to object to government intervention when it increases their costs, but when they’re extracting benefits, or proactively crafting and exploiting loopholes, those concerns subside. It’s what housing expert Charles Abrams referred to as “socialism for the rich, capitalism for the poor,” way back in the 1960s. When the pretenses of laissez-faire capitalism are paired with a healthcare system, it’s often fatal.
Now, at the end of 2020, President Trump is facing a tight race against Joe Biden. As he anticipates the votes of seniors, he knows that his administration needs to take steps to lower drug prices, or at least, be seen as taking steps. There’s a problem, though: there is little or nothing they can propose by way of a “free market” solution, because the free market is a large part of the healthcare problem.
President Trump even said that he hasn’t pursued a more aggressive version of an international price index (IPI) plan because he’s been “hoping that the pharmaceutical companies will come up with something that will substantially reduce drug prices.” It’s not clear why they would, and in fact, pharmaceutical execs seem to be hoping that this will just go away. Industry representatives have refused to meet with President Trump on this topic. Pfizer even claimed that the issue will “pose enormous distraction” from its COVID-19 efforts, and they threatened to cut jobs and reconsider U.S. expansions if the measures are implemented. In the meantime, the Trump administration and the Republican Party need to find a way to cloak the President’s attempted drug pricing reforms in language that resonates with their base.
Last December, President Trump, along with the HHS and FDA, announced plans that would make it easier to import certain prescriptions from Canada, under specific conditions. This notice of proposed rulemaking is legally required. At the end of July, the President signed four executive orders on drug pricing.
The pharmaceutical industry has long resisted drug importation programs, both directly and through industry-funded think tanks that pretend to be impartial and concerned with safety. The safety argument is somewhat disingenuous since the drugs sold in Canada and the United States often come from the exact same factories. That hasn’t stopped Republicans and Democrats alike from making this excuse, and keeping their pharmaceutical industry campaign contributions intact.
Under the revised rulemaking, programs for importation must demonstrate significant cost reductions to the American consumer. If the programs materialize, they probably will. But this should prompt curiosity about why they will.
Why are drugs cheaper in Canada in the first place? Try as the Republicans may to frame this as increased competition under free market conditions, it’s not. The drugs are cheaper in Canada because the country regulates the prices of generic and brand-name medications at provincial and national levels and has the bargaining power of a single-payer system. Under US law, the Secretary of the HHS isn’t allowed to negotiate lower drug prices on behalf of Medicare Part D beneficiaries; the Veterans Health Administration has this authority and pays dramatically less for drugs.
The language in the HHS press release works hard to maintain Trump’s political narrative, even though it’s really admitting to the failures of market mechanisms in healthcare.
A bullet point says that the executive orders will “take action to ensure that the Medicare program and seniors pay no more for the most costly Medicare Part B drugs than any economically comparable OECD country, ending foreign countries’ free loading off the backs of American taxpayers and pharmaceutical investments.”
That final phrase drives home the Trump narrative that America is continually being taken advantage of. But this maneuver is also benchmarking our drug payments against the payments made by other advanced countries, which have lower payments precisely because their governments take a more active role in national insurance and determining drug prices.
This globally combative sentiment is then repeated within a statement attributed to CMS Administrator Seema Verma: “American seniors will no longer foot the bill for the world’s innovation while other countries take a free ride.”
Note the deliberate reframing here. Actually, it’s the pharmaceutical companies that took a free ride off American seniors. Verma’s implication is that other countries didn’t have to pay as much for drugs because we were paying so much, effectively subsidizing innovation and global health. It’s a valid observation of a ripple effect, but it misidentifies the culprit. You can be sure that if those other countries didn’t have public entities demanding price caps and equitable medicine, they, too, would be paying exorbitantly. This strategic wording shifts the focus in order to mirror the isolationist and sometimes xenophobic worldview that the President promotes, rather than the anti-corporate worldview of the far left.
Throughout the HHS release, all of the statements attributed to public officials seem to fall in line with the Trump narrative.
HHS Secretary Alex Azar’s statement begins as follows: “President Trump has already done more than any other President to lower drug costs.” It’s a familiar-sounding hyperbole. The President recently claimed to have done more than any other US president to advance the interests of African-Americans – calling into question the legacies of Abraham Lincoln (who freed the slaves) and Lyndon B. Johnson (who passed the Civil Rights Act). President Trump claimed this even as civil rights protests continue, and even as he objects to the words “black lives matter” being painted on the avenue near his building.
A statement attributed to FDA Commissioner Stephen M. Hahn, M.D. reads: “We remain committed to advancing the policies outlined in the Safe Importation Action Plan, as quickly as possible, as we continue our broader work to increase drug competition to benefit American consumers.”
Here again, we see the out-of-place emphasis of an ideological talking point: “competition.”
Policy2050.com has previously explored the use of business language in-depth, through a whitepaper about ways to navigate jargon, an article about linguistic and philosophical meaninglessness in the world of tech, and an exploration of this publication’s distinguishing features in the cluttered, digital media landscape. The HHS press release serves as yet another case study: it shows how politicians and organizations try to maintain the appearance of consistency in their narratives, even as things change, because today, more than ever, perception is reality.
Within the solution that is suggested by the executive orders, there’s a concession that the American healthcare system is broken at its core; it’s just not explicitly conceded in the language. Trump seemed to know this when he first sought the GOP nomination and spoke highly of single-payer systems in Canada and Scotland, but he very quickly backed down and towed the party line. We could interpret these executive orders as a minor restoration of that original independence, heavily cloaked in contradictory language because of politics, but some voters may be left hoping for broader, more durable, legislative reforms.
These executive orders might not even pan out. As Helen R. Pfister and Ian Spatz of Manatt Health, a legal and business advisory firm, noted in a post today: “None of the initiatives that this EO seeks to advance are likely to have any major impact on U.S. patients or providers. The state importation rule would, if finalized, merely create a pathway for states to apply to the FDA to create a program. There is no guarantee that the FDA would approve a program.” Even if a state gained approval, Pfister and Spatz argue that restrictions would make any significant use unlikely.