When running for President in 2016, President Trump famously declared that Americans would be “tired of winning.” How this would feel is anyone’s guess, because those who go on winning streaks don’t tend to get tired of it. Especially when they’re cheating as is often the case in Washington.
Those who get cheated, on the other hand, tire of the experience quickly. Which brings me to the forthcoming hearing on drug prices scheduled for today in the Senate. It’s a common trope in Washington that “Pharma always wins.” The trouble is that the American people, who are the oens being cheated, are sick to death of that state of affairs. Today, the Senate will be able to decide whether they agree.
The precedent is not encouraging. While hearings on high drug prices are commonplace in Washington, and have been going all the way back to 1959, none of those hearings has yet led to any sort of congressional action on the question of drug prices. They have led to encouraging other developments on questions such as safety, even market-oriented drug pricing reforms like price transparency, or clearing unnecessary regulatory hurdles for generic drugs, have been fended off by the pharmaceutical industry for the past 60 years. So while it’s encouraging that the industry will be put on the hot seat in the Senate, a cynical observer has every reason to doubt that such public heat will translate into actual policy. More likely, that cynic would argue, it will be nothing but Kabuki theater designed to mirror public outrage without acting on it: sound and fury satisfying nothing.
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This take may well turn out to be correct. However, I would suggest that there are reasons why the Senate might act now that did not exist in the past 60 years.
To begin with, Pharma enters 2019 already in a bruised and battered state. Last year, the industry spent a record amount of money lobbying, only to see the Trump administration publicly rebuke them multiple times, with no pushback at all from Congress. In fact, Congress effectively told the industry to drop dead on one of their key policy priorities at the end of last year. For perspective, the last time Pharma spent anywhere close to as much money lobbying as they did in 2018, they were able to hold President Obama’s signature health care law hostage. That kind of shift in 9 years shows a profound decline in the industry’s power, not to mention, it suggests that having emptied their coffers so much last year, they may not be able to lay down so many resources going forward. The industry is, quite literally, spent going into Tuesday’s hearing.
Secondly, the industry is in the crosshairs of leaders of both parties. Along with the aforementioned brushoff the industry received from Congress late last year, it would appear that the one thing House Speaker Nancy Pelosi, President Donald Trump, and Senate Majority Leader Mitch McConnell all agree on is that drug manufacturers need to pay. In fact, the new Democratic Congress hadn’t even been seated when President Trump began negotiating with Speaker Pelosi on how to tackle them. The industry, reportedly, was “sweating bullets” over this, and rightly so. Even aside from their leadership roles, Trump, Pelosi, and McConnell are the strongest personalities in Washington politics right now, and each dominates their respective constituents and followers effortlessly. To have to contend with all three at once would be daunting even for the most entrenched power.
Thirdly, and closely related to the second point, Pharma faces a crisis of public confidence unprecedented in its history, and entirely of its own making: namely, the fallout from the opioid crisis. The fact that the industry created the painkiller epidemic is undisputed by either party. Indeed, that fact may well have been the determinative factor in winning Democrats the House, given that many of their candidates won over previously skeptical communities that suffered from opioid addictions by winning the battle over public trust on the healthcare issue. Both parties know this, and both parties have an incentive to try to one-up each other for the sake of not conceding the field on this issue again. Tuesday’s hearing will be an opportunity for both to begin that arm’s race, with Pharma in the crosshairs of whoever wins.
Does any of this necessarily mean the industry won’t walk out of Tuesday unscathed? No. Pharma has sixty years of practice dealing with angry legislators. That kind of institutional memory, coupled with their still formidable resources, could very well still prove decisive. But relative to where they have been in the past, they enter this fight crippled: possibly more crippled than they have ever been before. If Tuesday’s hearing draws blood, and it may, it will be up to the Senate to decide whether to stick by one of Washington’s wounded Goliaths, or stand with the Davids in America’s heartland who are tired of seeing that giant win.
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