Days before politicians will face voters who tell pollsters they’re angry and upset about health care issues, President Trump made his first visit to the nation’s giant Health and Human Services Department to roll out a much-promoted proposal to attack soaring prescription drug prices.

The plan was plenty wonky, replete with data about how much less patients in other, similar developed nations pay for drugs than Americans do. And despite the president’s assault on “freeloading” foreigners, it was murky as to the outcomes and fate of the administration’s latest drug cost-reduction proposal.

That’s because, buried in its pages of prose, it amounted to little more than a sketch of what experts have termed a big, rigorous clinical trial of an approach that’s anathema to Trump’s own purportedly free-market-loving party: price controls.

They would be rooted in executive powers Trump officials would wield under, yes, the Affordable Care Act. They would affect a small slice of medications, testing the federal government’s powers through the Medicare Part B program to hold or reduce prices and targeting select drugs as used not by patients (as in the big Part D program) but by doctors, notably cancer specialists. The savings would be as much as $17 billion, a tiny sum when compared with the exponentially higher expense of prescription drugs overall.

Those cancer specialists went to war on an earlier, smaller cost-cutting initiative by the Obama Administration. They’re likely to join an already furious Big Pharma battle against the Trump plan, which, so far, hasn’t been embraced either by the GOP or Democrats, the latter who long have wanted major changes in Part D so Uncle Sam could negotiate drug prices — an idea that Republicans have rejected from that program’s outset.

More reasons to be skeptical about this initiative:

• It seeks leverage from other nations’ price controls, without enjoying the ways they can bargain with Big Pharma. Europeans, for example, typically have officials and government health systems that dicker with pharmaceutical companies — and they can tell firms they’ll lose an entire nation’s business if they don’t deal. Uncle Sam won’t have this sway.
• The Trump plan, effectively, seeks to get Big Pharma to raise its overseas prices — potentially in testy foreign discussions — to win favor in the United States, potentially to reduce prices here.
• But, because the administration has termed this plan a “test,” U.S. officials face the real possibility that Big Pharma will pull products out of Part B use, rather than cut prices. It’s also worth noting that this plan initially will be set up, so it covers half the country, though officials haven’t said how that divide will be determined. That means Big Pharma might keep nose-bleed high prices in the unaffected areas of the nation, while taking cuts in the other half. Let’s see how well that might play politically.

When all is said and done, and with formidable opposition building already to this initiative, will the administration — which has gone on and off for months about its commitment to cutting prescription drug costs, even while the president has boasted about tackling the issue — stick by this plan? Or, as cynics (realists?) suggest, is this another last-minute political gambit to try to persuade voters that the GOP wants to do anything besides repeal the ACA and gut social support programs that tens of millions of Americans rely on for health coverage and care?

In my practice, I see the harms that patients suffer while seeking medical services, and their frustration, desperation, and anger in affording and accessing safe, efficient, and excellent medical care, especially with prescription medication prices skyrocketing and too many drugs downright dangerous. Contrary to what partisan extremists may argue, most Americans are political centrists and patriots — they want to support the president and to see him, his administration, and party improve the nightmare of the nation’s health care system, on which we spend $3 trillion a year.

But voters are not amnesiac, nor will they be treated as chumps: The president and Republicans cannot run away from their record, including their control of the House, Senate, White House — and now the supposedly nonpartisan Supreme Court. They have been relentless in their assault on the ACA and programs that American majorities support because they see how Medicare, Medicaid, and Social Security benefit their health.

Trump may Tweet to his heart’s content fact-free assertions, including his recent insistence that the GOP wants to protect on the most popular aspects of Obamacare — the protection against insurers declining coverage to tens of millions with pre-existing conditions.

More under-cutting of pre-existing condition protections

As if earlier evidence were insufficient to debunk the falsehood of the GOP opposition to theses and other key health coverage protections, the administration has just indicated through the Centers for Medicare and Medicaid that it would be generous in providing states waivers to pursue health coverages absent of ACA protections — including plans that lack protections for pre-existing conditions, so-called essential benefits, and lifetime limits.

This, of course, is a continuation of the GOP effort to push lower cost but also so-called short, skinny, or skimpy health coverages. Their monthly premiums may seem much more affordable. But experience has shown such plans, filled with fine print exemptions as to what they cover, will be worthless to policy holders at the precise time they need them — when they get sick or hurt.

If Republicans can push more Americans into these coverages, this not only undercuts Obamacare by removing healthy, younger people out of risk pools, increasing costs of ACA plans, it also, inevitably, could lead to employer-provided insurance minimizing its protections. The administration already has plans to ease rules on so-called Health Reimbursement Arrangements, prospectively allowing employers to provide funds to workers to get health coverage on ACA exchanges or anywhere else besides the workplace. While this is touted as a benefit, skeptics say it could become a means for employers to push sicker, older workers out of employer-provided plans, as well as enticing younger, healthier employees to seek skinny and useless coverage.

If your health and that of your loved ones and friends and colleagues matters to you, the midterms will be as important as any election in recent memory. Please exercise your privilege and right to make your views heard, and vote.