The problem is the government can’t set the price of goods in a private contract between two non-government entities, which is what would need to happen. The various bills you see in states setting co-pay caps is about as close as we can get, and that only happens because the government CAN regulate insurance companies and the policies they offer. While that might, eventually, put pressure on the insurance companies to demand lower prices from the manufacturers, it’s a long way disconnected from the price paid by the patient.

And regulating copays doesn’t help people without insurance at all.

That’s why this is such an important step. When prescription coverage was added to Medicare, the ability of the government to negotiate drug prices was specifically striped from the bill. The Inflation Reduction Act added it back, finally. And it’s a huge win. Medicare and Medicaid are enormous programs, and when they throw their weight around, they can affect the markets they’re in dramatically. It’s why the drug companies are already filing suit.

But the real solution isn’t trying to force private insurance companies to play ball, or make drug manufacturers sell at a low price, it’s to leverage that giant market pressure and expand Medicare eligibility to everyone. And if you’re worried about funding? Don’t be. Unlike social security, Medicare’s tax has no maximum wage.