There's been some drift on the Right, among both Trumpists and actual conservatives. away from the free-market orthodoxy that has always been one of the three pillars of the conservative worldview. Trumpists have been fine with tariffs, for instance (even though they have failed to produce the trade results that the VSG has promised.) Among actual conservatives, a strain of economic thought has arisen that posits that a sort of sociological view is needed, one that takes into account dislocation and the changing nature of labor.
My view is that conservatism by definition is about immutable principles - things that don't change. I stand by my LITD First Law of Economics: A good or service is worth what buyer and seller agree that it is worth, period. No other party has any business being part of coming to that agreement, most certainly not government.
Any other scheme smacks of central planning, no matter how fancily it's dolled up. It always comes down to a proclamation that "we have to do something for such-and-such sector of the population." The question that looms, then is always, "Who is 'we'?" I'd like to suggest that sovereign individuals are best suited to determine their own destinies. This remains true even as advances in technology, the proliferation of global supply chains and more diverse populations come about.
One person on the Right - I'm using that term very, very loosely; he was a Democrat as recently as 2009 - who is definitely not a free-market advocate is Donald Trump.
The guy has a lot on his plate these days: the Supreme Court vacancy, continued urban unrest, the ongoing pandemic, and, of course, the upcoming election. But in the middle of all that, he's found time to hatch a scheme the purpose of which is clearly to curry favor with the senior demographic:
President Donald Trump said that Americans in the Medicare program for the elderly and disabled will be sent $200 discount cards for prescription drugs within weeks, potentially putting cash in their pockets ahead of his November re-election.
“Nobody’s seen this before. These cards are incredible,” Trump said Thursday in a speech outlining what he called an “America First Health Plan” in Charlotte, North Carolina. “The cards will be mailed out in coming weeks. I will always take care of our wonderful senior citizens.”
Trump didn’t explain in his speech what program or authority would allow the government to provide the cards. Assuming they are sent to 33 million Medicare beneficiaries, the figure Trump used, the cards would cost about $6.6 billion.
Money for the cards will be drawn from a demonstration program Medicare uses to test new payment systems and other projects, and the cost will be offset by future savings generated from new price cuts Trump has ordered for drugs bought by Medicare, according to a White House official. The cards can be used for prescription drugs co-pays, the official said, but didn’t elaborate.
The Centers for Medicare & Medicaid Services referred questions about the cards to the White House.
Trump is struggling to secure the votes of older Americans with less than six weeks before the election. Several recent polls indicate his re-election opponent, former Vice President Joe Biden, is tied or leading Trump among people 65 and older, a turnabout from 2016 when the president won the senior vote by a comfortable margin.
Per the line above that I have emphasized with boldface, isn't this the sort of thing that needs to come out of Congress in the form of a passed bill?
James C. Capretta, writing at The Bulwark, says that this is just the latest attempt by the VSG to look like a hero to the senior set by lowering their drug prices, and that every stab he's made at it is extraconstitutional and incoherent:
According to the New York Times, in July and August, President Trump pursued one last (and probably illegal) gambit with the pharmaceutical industry to deliver lower prices to consumers.
He and his aides used the threat of pricing tied to an international benchmark to coerce the industry to agree to provide direct assistance to Medicare beneficiaries. The Times reports that major pharmaceutical companies were prepared to pay for $150 billion worth of cost-sharing relief for senior citizens if the administration halted its price-benchmarking plan. It is not clear from the story how the drug companies could provide such assistance under current law.
That wasn’t enough for Trump. He and his aides wanted drug discount cards—worth $100 apiece—delivered in October to every Medicare beneficiary. Medicare has 62.6 million enrollees in 2020, so this scheme would have required a one-time, $6.3 billion payment from the companies.
The industry’s negotiators balked at this request, and the deal fell through.
Two points are worth emphasizing about this remarkable episode.
First, this extraconstitutional behavior would have shocked the political world had it been attempted in a previous era. The executive branch was trying to force a private industry to pay for direct assistance to public program enrollees, one month before a national election. It seems not to have occurred to anyone at the White House that perhaps this was a matter that required legislation and a legitimate federal appropriation. If Congress wanted to create such a program, and make the industry pay for it, it could do so by imposing a tax and using the proceeds for this purpose.
Second, Trump and his aides seem incapable of deciding what it is that they want on drug costs. If the reporting is accurate, the industry was prepared to pay for substantial pricing relief for seniors, and thus deliver a victory for the president at a crucial moment in his term. And yet the administration couldn’t take yes for an answer. Top White House officials insisted on a request that was so outlandish that the industry had little choice but to reject it. The collapse has left the president with nothing to tout on drug pricing.
This latest failed negotiation with pharmaceutical companies fits a pattern. The president came into office saying he would deliver where his predecessors fell short, by lowering prices paid directly by consumers. But he has yet to put in place any meaningful reforms, in large part because he and his aides have never settled on a coherent plan and pursued it consistently. This is a recurring theme of his presidency, and reveals the limits of governance by instinct, erratic improvisation, and the roar of the crowd.
His fevered focus on winning the election is making for ever-crazier moves. I sure hope some folks in the House and the Senate muster the spine to speak out about this.
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