Not Bad For Half A Loaf

[ Posted Tuesday, November 2nd, 2021 – 15:44 UTC ]

I'm not usually that a big fan of (or any kind of rosy-tinted optimist about) legislative compromises. Or incrementalism, in general. But the deal Senate Majority Leader Chuck Schumer announced today on prescription drug relief doesn't actually sound all that bad. It certainly has its drawbacks -- parts of it are incredibly limited, for one -- but it also will fundamentally change things to the point where improving upon the basic idea will only require a little future number-tweaking. Which seems good enough, at this point (and with this Congress). So I have to say: this is not too bad for "half a loaf."

Prescription drug pricing reform is complicated -- there are a lot of ideas how to achieve it and a lot of things that could be done to rein in the worst excesses of the pharmaceutical industry (of which there are legion). This bill won't attempt them all, but it will do enough of them to build a solid base that can be later improved upon.

Here's a quick rundown of three of the biggest features of the announced deal:

Medicare can bargain for prices. Well, yes and no. This is where the "incredibly limited" part comes into play. In the first place, this won't happen until 2023, which puts any tangible benefit to the public beyond the midterm elections (but before the 2024 elections, I suppose). In the second place, in 2023, this will only allow Medicare Parts B and D to bargain for ten of the most expensive drugs on the market. Yes, you read that right: ten. Out of thousands. This will increase -- years later -- to possibly 30 drugs. Oh, be still my beating heart. No, really -- be still, if you're going to have a heart attack... please wait until 2028 or so, OK?

Out-of-pocket cap for seniors. Seniors on Medicare will have a yearly cap of $2,000 for the costs they'll have to pay for their prescription drugs. Once they hit this cap, their drugs will be fully covered for the rest of the year. This is a big deal, obviously.

Insulin price cap The out-of-pocket price [...or perhaps the total price the company can charge? This is not clear, as of this writing, sorry...] for insulin will be capped at $35 per dose. This is an enormous deal for diabetics, who have been some of the patients who have suffered the worst abuses by the pharmaceutical industry in recent years.

There are other more-technical changes in the deal as well, including some sort of inflation cap on how much the drug companies will be able to raise their prices each year, going forward (with "anti-price-gouging penalties") -- which may apply to private insurance as well as just Medicare. This benefit will begin at the start of 2022, but it is unclear how much the consumer will really notice this change.

There are a lot of details left to be filled in, some of them quite technical. But overall, it's not a bad half-loaf, especially this late in the game. Sure, parts of it are very weak. But, importantly, the fundamental changes will be put in place. The new systems and processes will be implemented, even if the numbers are currently pretty weak. This will mean a great deal later on, when some future Democratic effort seeks to strengthen the basic concept (to the point where it actually does have some teeth). It's a lot easier to lower out-of-pocket costs from $2,000 a year to $1,000 a year than it is to set it up in the first place, to put all of this another way. The numbers will be eminently tweakable, because the foundations will already have been laid.

That's a win, even if the initial phase of it will be less than it could have been. And it's a win considering the obstructionism it faced up until this point. When Joe Biden prematurely announced there was a deal last week on his Build Back Better plan, there was no prescription drug relief item left in it at all. He was already resigned to dropping it, just to get a deal. But perhaps people like Senator Kyrsten Sinema (and a few others, to be fair -- on this one she wasn't fighting all on her own for her big Pharma donors) realized that this was the most popular item in the entire Biden Build Back Better agenda and having to defend personally killing it to her voters in Arizona (many of whom are retirees) wasn't going to be an easy thing to do. Perhaps.

For whatever reason, however, Sinema and the others had second thoughts at the last possible instant. And they actually agreed to a deal that isn't all that bad. The worst part about it is how limited it is. The best part about it is how many things it is going to attempt to make better at once.

Politically, the absolute best part is the $2,000 annual cap on expenses for seniors and the $35 cap on insulin doses -- both of those will benefit millions of pocketbooks across America in a very direct way. It is unclear at this point when that annual cap will begin, but the sooner the better, because this will be absolute gold for Democrats on the campaign trail. This is going to dramatically change the lives of a lot of seniors for the better, so Democrats really need to own all the credit for it.

An annual cap on out-of-pocket expenses for seniors is a solid win. Capping insulin is a solid win. Trying to restrain the markets to the inflation rate can be a game-changer in the future. Bargaining for drug prices is laughably inadequate (only 10 drugs? Are you kidding?!?) but can be easily built upon in the future -- by just expanding it to 50. Or 500. For now, it builds a foundation Democrats can revisit and improve upon later.

Which is all why I say, overall -- for only a half a loaf, this one looks pretty good.

-- Chris Weigant


Follow Chris on Twitter: @ChrisWeigant


86 Comments on “Not Bad For Half A Loaf”

  1. [1] 
    Chris Weigant wrote:

    VA results coming in slowly...

    They changed their rules, now the counties count the mail-in votes before Election Day, so those are all the early reports... then they move on to early in-person voting, then they count today's vote. So it'll probably go back and forth quite a bit...


  2. [2] 
    Chris Weigant wrote:

    NYT, with est. 50% in...

    Youngkin up by 12 points, almost 190K votes. But it's still early...


  3. [3] 
    nypoet22 wrote:

    actually looking extremely close. youngkin still up big at the moment, but most of the big democratic strongholds are less than half reported.

  4. [4] 
    Chris Weigant wrote:

    Huffpost just called it for Youngkin... nobody else has, but that could be it... with 62% in...


  5. [5] 
    Chris Weigant wrote:

    I dunno where HP is getting their inside info from, nobody else seems to have called anything...


  6. [6] 
    nypoet22 wrote:

    decision desk? they have it at 78% reporting and over 200k difference.

  7. [7] 
    Chris Weigant wrote:

    Yeah, it's been above 200K for a while now... but McAuliffe never seems to gain much ground. Gap was as high as 12.5+, now down to 9+, but not shrinking very fast...


  8. [8] 
    Elizabeth Miller wrote:

    I'm glad the Democrat is losing in Virginia.

  9. [9] 
    Elizabeth Miller wrote:

    Check that ... I'm glad the Democrat lost the Virginia Governor's race. I just am.

  10. [10] 
    Elizabeth Miller wrote:

    Talk about shooting yourself in the foot.

    Will Dems ever learn?

    Not too damn likely.

  11. [11] 
    Chris Weigant wrote:

    LizM -


    (Gap below 9 points, McAuliffe seems to be moving a little...)


  12. [12] 
    Elizabeth Miller wrote:

    Hate to say it but, HP is dead on balz accurate! Ahem.

  13. [13] 
    Chris Weigant wrote:

    I mean, I'm not a big McAuliffe fan in general, but did want to see him edge it out, just to avoid all the blather from the pundits...


  14. [14] 
    Elizabeth Miller wrote:

    I've been thru too many of these to know a McAuliffe win ain't in the cards tonight. And, he has only himself to blame.

  15. [15] 
    Elizabeth Miller wrote:

    Oh, I wanted to see him win, too!

  16. [16] 
    Elizabeth Miller wrote:

    But, alas, he's a Clintonian Democrat. Hopefully, last of a dying breed. And, thank the Gods for that.

  17. [17] 
    Chris Weigant wrote:

    I did hear he ran a terrible campaign, but don't know anyone personally in VA, so have no info on a personal level on that one...


  18. [18] 
    Chris Weigant wrote:

    Yeah, that's what I have against him too. And old Clintonista. As I recall, he was like "chief fundraiser" or something along those lines. Was kind of surprised when he first won there...


  19. [19] 
    Elizabeth Miller wrote:

    I don't know anyone in Virginia, either ... well, not that I know of, anyways.

    But, I did hear what he said about the kind of say parents should have in their kids' education. Heh.

  20. [20] 
    Elizabeth Miller wrote:

    May I say, Chris, this is THE best place on the internet(s) to chat about US election races!

  21. [21] 
    Elizabeth Miller wrote:

    Let me also admit that I don't think Biden (or any Democrat) would ever have been elected US president if he wasn't running against Trump.

    There are lessons to be learned if you're a Democrat running for higher and high office.

    Will they ever get learned?

  22. [22] 
    Chris Weigant wrote:

    LizM [20] -



  23. [23] 
    MtnCaddy wrote:

    Regarding today's post, I agree that as half loaves go, this one ain't bad.

    But it ain't over until its over, so I'm still kicking back and waiting for the final results. And the details, of course.

  24. [24] 
    nypoet22 wrote:

    even new jersey seems surprisingly close at the moment.

  25. [25] 
    Elizabeth Miller wrote:

    Not surprisingly.

  26. [26] 
    nypoet22 wrote:

    surprisingly for anyone who knows new jersey.

  27. [27] 
    Elizabeth Miller wrote:

    There just must be a Grateful Dead song for this ...

  28. [28] 
    Elizabeth Miller wrote:

    not surprisingly for anyone who has been following things closely for the last few years.

  29. [29] 
    nypoet22 wrote:

    you've been following new jersey closely?

  30. [30] 
    Elizabeth Miller wrote:

    Close enough. :-)

  31. [31] 
    Elizabeth Miller wrote:

    I am about ready to book a trip to Mars - that's how closely I've been following things for too, too long, Joshua

  32. [32] 
    Elizabeth Miller wrote:

    ... on a one-way ticket, that is

  33. [33] 
    nypoet22 wrote:

    did you read my lyrics?

  34. [34] 
    Elizabeth Miller wrote:

    You'll have to provide another link ... heh

  35. [35] 
    Elizabeth Miller wrote:

    Hehehehehehehehehe ... I may be drunk, or something ...

  36. [36] 
    nypoet22 wrote:

    regarding virginia, i think we shouldn't discount the specific attraction of the republican candidate to virginia voters. youngkin, if not never-trump, is at least decidedly non-trump. i think that's where most sane people hope the GOP are headed.

  37. [37] 
    Elizabeth Miller wrote:

    very salient point, joshua

  38. [38] 
    nypoet22 wrote:

    okay liz, i posted it sunday night, but in any case...

    here you are again.

  39. [39] 
    nypoet22 wrote:

    dead heat in NJ

  40. [40] 
    nypoet22 wrote:

    most of the reported results in NJ so far don't include the major democratic strongholds, so even though the republican currently leads, he'll still need to pull off a stunner to hang on. not that it isn't possible, mind you...

  41. [41] 
    Elizabeth Miller wrote:

    Yes! I did read your lyrics.

    Something happened Sunday night ... not sure what ... but I lost all internet connection ... ??

  42. [42] 
    nypoet22 wrote:

    it wasn't all the internets, it was this site. wouldn't load for about a half hour.

  43. [43] 
    Elizabeth Miller wrote:

    oh, i see ... well, will have to continue next Sunday ...

  44. [44] 
    Chris Weigant wrote:

    MtnCaddy [23] -

    Yeah, I hear you. Especially this year...

    nypoet22 -

    I haven't even checked Jersey, looks like I should. I did check Buffalo mayor, but no results last time I looked...

    LizM [27] -

    "I may be going to Hell in a bucket,
    But at least I'm enjoying the ride"



  45. [45] 
    Chris Weigant wrote:

    Site was down? Might have been my ISP upgrading, on a Sunday night, dunno, I'd have to check...

    Sorry to all I've been so scarce here, too.

    Mea culpa maxima.


  46. [46] 
    Elizabeth Miller wrote:

    That'll do. :-)

  47. [47] 
    Elizabeth Miller wrote:

    Oh, Chris, you just don't really care for music, do ya?

  48. [48] 
    Elizabeth Miller wrote:

    So, do ya think you could do your ISP upgrading on another night of the week, huh!?

  49. [49] 
    Elizabeth Miller wrote:

    Sorry to all I've been so scarce here, too. Mea culpa maxima.

    Hmmmm ...

  50. [50] 
    MtnCaddy wrote:

    Leave the poor guy alone, Elizabeth.

  51. [51] 
    MtnCaddy wrote:

    Yeah, I wondered what was going on Sunday night. I was a little concerned for you, Gurl.

  52. [52] 
    nypoet22 wrote:

    @cw [RE: NJ]

    ciatarelli(R) up 50K votes with a little over half the state reporting.

  53. [53] 
    Elizabeth Miller wrote:

    The poor guy?

    I was okay ... a little on the perturbed side but, mostly okay and a lot tired, so ...

    Where were YOU, by the way?

  54. [54] 
    Chris Weigant wrote:

    Then there's always "Throwing Stones"

    And the whole world full of petty wars
    Singing I got mine and you got yours
    While the current fashions set the pace
    Lose your step, fall out of grace
    The radical, he rant and rage
    Singing someone got to turn the page
    And the rich man in his summer home
    Singing just leave well enough alone
    But his pants are down, his cover's blown
    And the politicians throwing stones
    So the kids, they dance, they shake their bones
    'Cause it's all too clear we're on our own
    Singing ashes, ashes, all fall down
    Ashes, ashes, all fall down

    Picture a bright blue ball just spinning, spinning free
    It's dizzying, the possibilities
    Ashes, ashes, all fall down
    (Ashes, ashes, all fall down)


  55. [55] 
    nypoet22 wrote:

    virginia is tightening up a bit with 91% of the state reporting, but it looks like the guys who called it early called it correctly.

  56. [56] 
    Elizabeth Miller wrote:


    But, not quite enough to compensate for, ya know ...

    so, i think i'll spin a few Dead tunes this coming Sunday night ... just for you!

  57. [57] 
    Chris Weigant wrote:

    LizM -

    Sorry, I've got no control over my ISP. They're a little tiny local operation, which I love because that way a giant corporation doesn't ever deal with my data. But it does have its drawbacks, I will admit...

    Oh, could have been a storm outage too, our power's been kinda blinky, rainy season has started early...


  58. [58] 
    Elizabeth Miller wrote:

    Good luck to the Dems in 2022!



    When will they ever learn, when will they ever learn ...

  59. [59] 
    nypoet22 wrote:

    is that pete seeger?

  60. [60] 
    Elizabeth Miller wrote:


    I could have been just too damned tired, too.

    I'll be more awake next week ... er, this week!

  61. [61] 
    Chris Weigant wrote:

    WTF is the deal with NJ?

    I thought this one was a cakewalk...


  62. [62] 
    Elizabeth Miller wrote:

    Shocking. Positively shocking.

  63. [63] 
    Chris Weigant wrote:

    nypoet22 -

    Oooh, I know this one: "What is 'Where Have All The Flowers Gone?', Alex?"



  64. [64] 
    Elizabeth Miller wrote:

    Wanna come to Mars with me? Heh.

  65. [65] 
    Chris Weigant wrote:

    Don't tempt me...

    But VA seems to be within 2-3 points right now... running out of votes to count, but it does seem like it might come down to the wire... feeling better about it now than I was 1/2 hr ago, at any rate...


  66. [66] 
    Elizabeth Miller wrote:


  67. [67] 
    nypoet22 wrote:


    NJ is the most densely populated state in the nation. so when the republicans really get motivated and turn out to vote, they can cancel out the democratic-leaning urban centers. NJ almost always goes blue in presidential elections because on average it's more socially liberal than the nation overall. however, homegrown conservatives aren't as hamstrung by "culture wars" campaigning, so they win with some regularity on regional issues and personal appeal.

  68. [68] 
    nypoet22 wrote:

    Jack Ciattarelli

    Philip Murphy*

    74% counted

  69. [69] 
    Elizabeth Miller wrote:

    There is hope?

  70. [70] 
    nypoet22 wrote:

    i think NJ may be headed for a hand recount.

  71. [71] 
    nypoet22 wrote:

    who's hope?

  72. [72] 
    Elizabeth Miller wrote:


  73. [73] 
    nypoet22 wrote:

    well i gotta go teach in the morning, so nitey nite all.

  74. [74] 
    Elizabeth Miller wrote:

    g'nite joshua ... always a pleasure!

  75. [75] 
    Chris Weigant wrote:

    CNN just called VA for Youngkin...

    I'm walking away from the computer now...



  76. [76] 
    Elizabeth Miller wrote:

    I think Youngkin's win is a good thing for Democrats.

    If they know what to do with it, that is ...

  77. [77] 
    MtnCaddy wrote:


    Do you mean if Dems start running Progressive candidates with Prog policies instead of Republican-lite DINOs? I'm as disappointed about McAullife losing as I was about Hillary losing. Good. I recall thinking. A President Hillary would have set back Progressives at least 8 years. Trump may well suck so bad it creates an opening for the Democratic wing of the Democratic party.

    I'm prepared to ignore the thousands of upcoming What It Means columns, just like I strictly ignore all the blow-by-blow accounts of Dem's sausage making. Bottom line results are the only thing worth giving a fuck about.

  78. [78] 
    Elizabeth Miller wrote:

    I just heard Axelrod, a political genius (so-called by the CNN morning host, ahemm) say that the reason Republicans did so well last night was because, you know, the party in power always doew badly and the people are feeling pretty ornery, presently, and, well, this is all a natural course of events given how people are feeling.

    Can Dems really be that stupid?

  79. [79] 
    Elizabeth Miller wrote:


    No, not what I mean.

    And, I don't think Dems know what to do with it, anyways so, my point, if I had one, is moot. :)

  80. [80] 
    Don Harris wrote:

    Not a fan or optimist of legislative compromises or incrementalism in general?

    That is pretty much the equivalent of saying "I'm not a racist, but....".

    Somehow your half a loaf theories (that are usually closer to half a slice) and building a base that can be improved on later never gets applied to One Demand the way you seem to apply it to everything the Deathocrats pretend they are trying to do.


  81. [81] 
    Don Harris wrote:

    Mtn Caddy-
    "Bottom line results are the only thing worth giving a fuck about."

    Decades of results just like recent ones are worth more than giving a fuck about- they demand that something be done about it.

    You are right to ignore most of the what does it mean columns as they will be more of the bullshit that produced the decades of substandard results, but you still need to consider what it means.

    What it means is that Democrats need to stop buying into the show and stop voting for Deathocrats.

    As long as citizens keep accepting and validating more of the same empty promises and substandard results without demanding better we will keep getting substandard results. Empty threats of not voting for Deathocrats followed by giving them another chance are not an incentive to change.

  82. [82] 
    Kick wrote:

    I was at a Rolling Stones concert last night and missed all the election returns, which went about how I expected... except New Jersey governor, expected around a 5-point win for Murphy... did not see that coming.

    It was cold and wet and a wonderful concert, and somebody streamed it live:

  83. [83] 
    Kick wrote:

    Y'all would not believe the crowd of QAnon Trump cult nuts that invaded downtown Dallas yesterday waiting for what they insisted would be the deceased Kennedys making a reappearance. They were expecting John F. Kennedy Sr. being resurrected and shown to the world on 11/2 in Dallas where he was shot at the "grassy noel" at "Deiley Plaza." They referred to it as "the beginning and the end." They expected JFK Sr. would then transfer power to Donald Trump (as if that was "a thing") and that JFK Jr. would become Trump's vice president -- "any day now" -- and still clinging to that from a previous move of the goalposts. They referred to it as the "second coming of Christ" because they believe the Kennedys are the "Jesus bloodline."

    When not a single one of the deceased Kennedys returned to the "grassy noel" at the expected time, the goalposts were moved to the Rolling Stones concert, where I can report firsthand that John F. Kennedy, Sr. -- who would be 104 years old today -- did not appear to anoint Trump as POTUS and Jr. as VP.

    I did, however, see a lot of other old guys making some noise.

  84. [84] 
    Kick wrote:

    Mtn Caddy

    Bottom line results are the only thing worth giving a fuck about.

    Well put... I mostly agree.

    As for Don Harris, he is the board expert on getting "substandard results" where nothing ever changes and he doesn't "consider what it means." People aren't buying into his repetitive "show," and it's always the "same empty promises and substandard results without demanding better" of himself. Tragic, really.

  85. [85] 
    BashiBazouk wrote:

    Kick -

    Didn't they get the memo the Kennedys are democrats?

    Think they might settle for a Dead Kennedys reunion concert?

  86. [86] 
    Kick wrote:


    Didn't they get the memo the Kennedys are democrats?

    I know, right! They simultaneously believe that the Clintons had JFK Jr. killed -- Roger Stone conspiracy bullshit -- and also that he's alive and will (any day now) become Trump's Vice President... as if John F. Kennedy, Jr. would actually serve as Don the Criminal Con's Vice President if he weren't deceased, cremated, and buried at sea.

    Comprehending facts and connecting dots: Not their strong suit.

    Think they might settle for a Dead Kennedys reunion concert?

    Heh... punk. ;)

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