Trump’s Position On Medicare Drug Pricing Just Flipped Again. Unless It Didn’t.

President Donald Trump’s on-again-off-again promise to have the government negotiate drug prices directly with pharmaceutical companies is back on again.

Maybe.

During the presidential campaign, Trump said he wanted the federal government to use its bargaining leverage to extract lower prescription prices for Medicare beneficiaries ― in effect, doing for seniors what governments in other countries have long done for their citizens.

In saying that, Trump seemed to break sharply with Republican lawmakers, who have traditionally opposed giving the U.S. government that power. He also seemed to pick a big fight with the pharmaceutical industry, which is among the most influential in American politics.

But last week, after meeting with several drug company executives at the White House, Trump appeared to back away from his promise.

“I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said. “That includes price-fixing by the biggest dog in the market, Medicare, which is what’s happening.”

Like so many other policy pronouncements from the Trump White House, those statements were sufficiently ambiguous to invite different, even conflicting interpretations of exactly what the president meant.

Fast forward to Tuesday and the daily White House media briefing, when NPR’s Mara Liasson asked Press Secretary Sean Spicer to clarify, once and for all, what Trump’s actual position is.

Here’s how the exchange went:

Liasson: So is he for Medicare negotiating drug prices or not?

Spicer: He’s for it, yes. He wants to make sure …

Liasson: He’s still for it?

Spicer: Absolutely.

Liasson: OK

From there, Spicer gave a slightly disjointed explanation of what he meant. Here it is:

The president’s clear. The president’s clear. I mean, when you look at the cost of ― not to drug costs. The U.S. government has not done. I mean, you look at what other, frankly ― the easier way to look at this is what other countries have done, negotiating costs to keep those down.

After that, Spicer talked about the burden that drug prices place on seniors and ended with a paean to Trump’s negotiating skills:

His commitment is to make sure, is that he does what he can and rather successfully use his skills as a businessman to drive down.

If Trump decided to take this idea of negotiating drug prices seriously, and if Congress signed on, there is the potential to deliver savings both to seniors and to taxpayers ― although the amount of savings would depend entirely on how much negotiating power the federal government actually had. (In other countries, governments can refuse to cover certain drugs altogether in their health care programs. That gives them the leverage to win big discounts.)

But while polls suggest most Americans support government negotiation on drug prices, getting a proposal through Congress would be politically difficult. Even many Democrats would oppose the effort, simply because, like Republicans, they depend heavily on campaign contributions from the drug industry ― and live in fear of negative advertising that the pharma lobby could deploy against them.

Of course, whether Trump really supports the notion of government negotiating prices is anybody’s guess. Notwithstanding Spicer’s very direct answer to Liasson’s very direct question, the end of Spicer’s response leaves open the possibility that Trump envisions a different kind of strategy on drug prices.

Specifically, it’s possible the president imagines he will personally sit down with drug company executives, and badger or cajole them into knocking down the prices of their products  ― in much the way Trump has promised to go after companies that threaten to move operations overseas.

It’s also possible that the president and his advisers have not worked out a clear position on how to reduce the price of prescription drugs.

In other words, Tuesday’s statement from Spicer could have no significance at all.

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