This Island Derp

It's Trump voters against the world -- literally

(c) 2017 Roy Edroso.

I guess you don't need another example of how Trump turns everything to shit; but I figure, when we're all in the camps our brains will probably deteriorate rapidly from the starvation diet and beatings; so, if we stock up on evidence now, when the Germans finally liberate us we’ll stand a chance of remembering at least some of it, which will make the work of the War Crimes Commission easier.

The Centers for Medicare and Medicaid Services released an Advance Notice of Proposed Rulemaking (ANPRM) yesterday that, among other things, suggests the administration will rebase Part B Medicare drug prices. These currently track the average sales prices of those drugs in the U.S. plus a 6% surcharge that's supposed to make it worth the providers’ while. But CMS says starting in 2020 it intends to base them on international drug prices, mainly from Western democracies where socialized medicine helps keeps drug prices much lower than they are here in the capitalists' paradise. At the same time, CMS intends to jack up the surcharge providers get.

Health and Human Services, the agency that runs CMS, is headed by Alex Azar, a former Eli Lilly executive, and it is impossible to believe that he intends to hurt his old pharma buddies in any way, so I expect by the time this goes from ANPRM to proposed rule to final rule it will take on some specific modifications that will keep the boys happy. But two weeks before an election is a good time to make this plan look like sunshine and lollipops for everybody.

You'd think Trump would be content to flaunt the lower-prices-more-pay angle. Sure, it's hypocritical, and news outlets haven't been shy about pointing that out. (“Many of the countries Trump referred to also have health-care systems that dictate prices or negotiate directly with pharmaceutical companies — the type of single-payer arrangement that Trump and Republicans have repeatedly attacked,” says Bloomberg News.) But it's still in the ballpark, if only just, of normal American electoral politics — promising a windfall to anxious seniors in exchange for their votes.

But in his remarks on the announcement yesterday, Trump took it to another level:

For decades, other countries have rigged the system so that American patients are charged much more — and in some cases much, much more — for the exact same drug. In other words, Americans pay more so that other countries can pay less. Very simple. That’s exactly what it is. It’s wrong. It’s unfair. It’s not surprising. I’ve seen trade deals where it’s far more costly to us than even this. And we’re changing them also.

Foreign countries even threaten to disrespect our patents if they are not given cheaper prices on drugs. So they’re not going to even look at the patents.

(I believe he's talking here about AIDS drugs which activists have muscled pharmaceutical companies into marking down for poor countries.)

They’ve been very, very disrespectful, previously, to our country and to all of the things that we stand for. And especially, they would disrespect patents when it came to American-made drugs.

The American middle class is effectively funding virtually all drug research and development for the entire planet. So we are paying for it. We are subsidizing it. Everybody else is benefitting. And they are paying nothing toward research and development.

The world reaps the benefits of American genius and innovation, while American citizens — and especially our great seniors, who are hit the hardest — pick up the tab. But no longer.

Trump's talking about other nations using the power of the state to demand — and get — lower prices from drug companies for their citizens. But he portrays it as “rigging the system” and making us “pick up the tab,” and finally as an attack on Our Seniors. It's as if, by negotiating the best terms for themselves, countries like Spain, France, and Canada didn’t set an example that America finds effective and wishes to emulate — an explanation another kind of president might offer, but which would be weak, I suppose, in Trump terms. No, these countries have done something underhanded and dirty that has pissed America off. That's where the bit about “disrespect” comes from — it shows exactly the kind of absurd outrage and indignation over nothing that one would expect from an opera buffa Mafia don. And he finishes by portraying his big price-off as a way of getting revenge on the insolent foreigners.

When Trump first came into politics with his nativist guff, I figured Latin Americans, MS-13, and maybe ISIS would be his go-to boogiemen — swarthy foreigners coming to steal our jobs and rape our women. But that's just the crudest tool in his kit. In reality, Trump's play is to define his followers’ world — or rather, convince his followers to define that world themselves — in the narrowest possible terms, and then make everything outside of that world their enemy.

That's why he and his cronies go on and on about Chicago and California and indeed anyplace Democratic or urban, and talk about these jurisdictions like something out of Death Wish while people who actually live there or have even visited for any length of time wonder what the hell he's talking about. That's why, when he and other conservatives talk about their hated "elites," they make it clear that they mean anyone who can read and write and isn't living under a bridge but still doesn't love Trump.

Conservatives want voters under their sway to live in the tiniest possible world. They want them to pull back their borders — back from anything foreign or intellectual or artistic or citified — from murderous Muslims and Mexicans and greedy-yet-overindulgent-of-refugees Europeans, from SJWs who won’t laugh at their feminazi jokes, from smooth-handed city slickers and rough-handed union bosses — until all they know, all they can see, all they can trust and love and mix with, is people like themselves. Then they'll support Trump no matter how much he steals from them and makes their lives shit because, unlike all those weak presidents who talked about equality and diversity, he has protected them from the awful rest of the world, by telling them just how awful it is.

Good weekend, friends, see you back here on Monday.