The older Americans get, the more reliably they vote — particularly in midterm elections. Historically, seniors have leaned conservative, but in the 2020 election they broke for Donald Trump by a margin of just 5 points. Accordingly, Democrats are planning an election pitch this year aimed at this critical group.
They’re bolstered by actually having put a number of policies and regulations into place that will directly benefit seniors. They include cuts in drug costs for Medicare enrollees under the Inflation Reduction Act and the Food and Drug Administration’s recent approval of over-the-counter hearing aids. Unfortunately, Democrats’ chronic timidity — and the substantial number of party members who are comically in hock to the pharma lobby — have sharply limited the effectiveness of the drug price reforms, in particular.
President Joe Biden and congressional Democrats will have a decently good pitch to offer seniors this Election Day. But with only small changes, it would have been a lot better — and should Democrats hold Congress, it should be easy to improve things before the 2024 election.
First, the policies. Last week, the FDA finalized a new rule allowing over-the-counter hearing aids that will allow most types to be sold without prescriptions, though not ones for the severest types of hearing loss. The rule has been long in the making. Most insurance doesn’t cover hearing aids, and neither does Medicare, so Congress passed a bipartisan bill allowing for over-the-counter sales back in 2017 — but the Trump administration sat on it. Biden issued an executive order last year to speed the process.
Americans have long been mercilessly price-gouged by medical device manufacturers who have set up an oligopoly — just five companies control 90% of the hearing aid market. It’s especially indefensible in the case of hearing aids because of their technical simplicity. We’re not talking pacemakers or insulin pumps here — they’re basically just microphones and speakers. Back in 2015, the Obama administration released a report finding the average price of a hearing aid was $2,400, while experts estimate they cost only $100 to $300 to manufacture. Since then, the price has ballooned to about $4,000. That’s the main reason even though roughly 30 million people in the U.S. have some hearing loss, just 16% use hearing aids.
By contrast, Bose — a luxury brand! — reportedly has an FDA-approved model ready to go that would cost $850. Sales should start within the next two months, and given that people with hearing loss tend to be elderly, that’s all to the good for the Democrats’ midterm pitch to seniors.
The story isn’t so good with drug prices. The background here is that Medicare was famously prevented from negotiating the prices of drugs as part of the Part D prescription drug benefit passed during the Bush administration (a provision inserted in part by a Louisiana Republican who quit Congress immediately afterward to be paid tens of millions as the CEO of PhRMA, the pharmaceutical lobbying group).
As David Dayen explains at The American Prospect, the Inflation Reduction Act enables Medicare to negotiate the prices of 10 drugs at first, with more added in subsequent years, and it caps out-of-pocket drug spending at $2,000. But the new drug prices don’t take effect until 2026, and the cap doesn’t take full effect until 2025 — that is, after the next presidential election — though a $4,000 cap will be in place for 2024.
These delays are ridiculous. Any functioning state ought to be able to carry out a handful of price negotiations in a few weeks, if not hours, and there is no reason to limit the number of drugs to just 10 at first or indeed to limit the number at all. Doing so effectively makes the bill more expensive, since Medicare will save less money.
As Dayen points out, the whole of original Medicare took just one year to implement. “The only plausible explanation for this is that drug companies asked for more time before the negotiations kicked in, and got just that,” he writes. Moreover, if negotiations take some time, then the spending cap should take no time at all — all that is required is some simple arithmetic.
All this throws a wrench into Democrats’ messaging. Right now, they are rightly trumpeting what they’ve done with the Inflation Reduction Act, but the drug price measures come with numerous asterisks that step on the messaging. “Vote for us — we helped you starting in 3½ years” isn’t an argument likely to spark enthusiasm.
Even Sen. Joe Manchin, D-W.Va., understands that the slow rollout is folly — and he blames his fellow moderate, Sen. Kyrsten Sinema, D-Ariz. “We had a senator from Arizona who basically didn’t let us go as far as we needed to go with our negotiations and made us wait two years," he said in video of a roundtable last week.
Trump, for all his flaws, instinctively understood what to do in a situation like those the Democrats face. When the $1,200 CARES Act checks were going out, he instantly grasped the political value of such a speedy, clear benefit. He demanded that his name be put on them and that they be sent with a boastful letter. When delivering a benefit to the public, a politician is wise to keep it simple and quick and loudly take credit. If Democrats do manage to hang on to Congress, they would be well advised to adjust their drug price reforms to be more aggressive and faster and to do the same thing with future policies.