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Conservatism, Inc. Gives Trump Country the Middle Finger

The opinions expressed by columnists are their own and do not necessarily represent the views of

This week marks the one year anniversary of when President Donald Trump achieved one of the greatest electoral upsets in the history of American politics. How he did it is still a matter for debate, but certainly his populist message was a prominent ingredient, with its equal skepticism toward bureaucratic government (“the swamp) and toward profiteering, abusive corporate entities.

What a difference a year makes. Now, just like Ed Gillespie in Virginia, who the president correctly derided for “not embrac[ing] me and what I stand for,” large sections of the Trump White House have become a vehicle by which profiteering, abusive corporate entities weaponize the bureaucracy on their behalf. To be fair to Trump, this pattern has mostly manifested in areas that no president has time to micromanage. However, most presidents don’t have a vice president who's close to rogue billionaires opposed to their boss.

Nowhere is this more apparent than in the administration’s recent moves on drug-related issues. Despite being ostensibly governed by a President who repeatedly accuses pharmaceutical industries of gaming the system and of “getting away with murder” as a result, the President’s Department of Health and Human Services (HHS) is apparently determined to be accessories to the very murder that Trump accuses Pharma of perpetrating. For instance, despite declaring the opioid crisis a national emergency, HHS has shown zero appetite for holding the pharmaceutical industry publicly accountable for its own (large) part in causing that crisis through changes in policy. There hasn’t even been a Presidential tweet denouncing predators like the Sackler family, who turned the abusive marketing of painkillers into an empire. This is in stark contrast to the very Trumpian Justice Department that Attorney General Jeff Sessions is running, which recently arrested one executive for his role in “a nationwide conspiracy to profit by using bribes and fraud to cause the illegal distribution” of opioids.

But at the same time Sessions was clapping irons on this up-jumped drug dealer, HHS decided to undermine one of the few cost control programs favored by everyone from free market advocates for seniors to liberal democrats: the 340B drug pricing program. 340B requires drug companies that sell their products to Medicare Part B and Medicaid patients to also offer those drugs at lower prices to hospitals in need, such as, disproportionate share hospitals and rural referral centers.  It is, vintage Republican policy with roots as far back as the first Bush administration and remains one of the few completely pro-free market and pro-tax payer drug cost control measures on the books. It costs taxpayers nothing, and holds companies that want to hoover up Medicare and Medicaid dollars to act like responsible corporate citizens in exchange. Picture of good government, right?

Well, not according to the Trump White House’s Center for Medicare and Medicaid Services (CMS), which finalized a new rule slashing reimbursements to hospitals under Medicare Part B by 30 percent. Never mind that this change quite arguably violates the original 340B law, and possibly even the Medicare statute itself. Never mind that bipartisan legislators favor the program. Never mind that, as Jim Martin of the right-leaning 60 Plus Association rightly points out, the program particularly benefits hospitals that serve Trump’s constituencies, such as blue collar workers, veterans and rural voters. No, all this is to be ignored for the sake of satisfying establishment donors from Big Pharma.

This kind of ham-fisted adherence to the economic dictates of the Republican donor class is not merely an offense to the people who voted for Trump expecting an economic fair deal: it is also politically extremely stupid as a matter of keeping Trump voters in the fold. With decisions like this, small wonder that voters in so-called “Trump Counties” think they’re worse off. They still haven’t gotten Trump policies. Furthermore, programs like 340B quite arguably offer one way to prevent the kind of viciousness that led to the opioid epidemic: companies are less likely to unethically push poor people to buy drugs they don’t need if they know those people are going to get those drugs at reduced prices anyway.

All of which is to say that when President Trump finally chooses his next HHS secretary, he should probably look for someone a bit more like Jeff Sessions. And in the process, he might consider also reminding Mike Pence that whatever the donor class might want, Pence isn’t president, yet.

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