The Cheshire Act: Disappearing Legislation

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Signing the Cheshire Act — the disappearing remnants of President Biden’s agenda.

You see? We can get things done in Washington! This Congress can pass legislation that the people want! We just did it! We gave Medicare permission for the first time ever to negotiate prices with the pharmaceutical companies! This will save consumers hundreds of billions of dollars!

Not to be curmudgeonly, but the only reason Medicare has been unable to negotiate with drug manufacturers until now is that Congress passed a law forbidding it when it authorized Medicare Part D to pay for prescriptions 16 years ago. It was a corrupt and brazen sop to Big Pharma, with the result that Americans pay more for their medicines than the people of any other civilized country. 

So fine, Congress — or, to be accurate, Democrats in Congress without a single Republican vote — has taken the first steps to correct the situation.

EXCEPT THAT Medicare is not allowed to conduct any negotiations with Big Pharma until 2026. That is after this year’s midterm elections and after the next presidential election. Which means that no voter will experience any benefits from this legislation until after the next two election cycles. Master strategists, those Democrats. Yet again, having promised relief to people who will receive no relief (until much, much later), the government has tanked its own credibility.

AND EXCEPT THAT when Medicare does begin to negotiate, in 2026, it is permitted by Congress to negotiate the prices of only 10 of the most expensive drugs. 20,000 prescription drugs on the market in the United States and they get to play with 10. Don’t worry, though, the floodgates open in 2027 (which, just to keep track, is five years away), when the number of drugs subject to negotiation skyrockets — to 15.

AND EXCEPT THAT several classes of drugs are excluded from this legislation, meaning that Medicare can do nothing at all, ever, about their cost: drugs for which generic alternatives exist; drugs that have been approved for less than nine years; and drugs that are the only ones approved to treat certain rare conditions (for example, a drug approved this month to treat a rare blood disease that costs — wholesale — $2.8 million).  

AND EXCEPT THAT giving Big Pharma five years to prepare for the actual effects of the legislation to be felt (presuming that it hasn’t been repealed by then) gives it time to exercise the skill it is perhaps best at — gaming the system so as to neutralize any attempt to limit their profits. After all, they spend $160 million a year to lobby Congress and give $150 million a year to Congressional candidates. So they are not exactly helpless in the face of a vicious crackdown on their business model.

Once again, Washington demonstrates that the height of political skill is not to do something to help people, but to appear to do something for people while not harming their oligarch benefactors. 

It is as the Cheshire Cat said to Alice (just before disappearing): “We are all victims-in-waiting.”