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The leaders of both parties appear to agree that the United States is facing an “affordability crisis,” with healthcare at its core. In mid-January Democratic Senate Leader Chuck Schumer declared, “Americans are in the middle of a healthcare emergency.” The next day President Donald Trump W’68 basically agreed, saying that over the past decade or so Americans have “paid more money for healthcare every single year—more and more the premiums went higher and higher.” But there’s no agreement on how to make healthcare more affordable. According to Schumer, Republicans “have no plan to solve the health crisis that’s been brewing under their watch.” Trump, who has long blamed Barack Obama’s Affordable Care Act, has lately responded with concepts such as cutting kickbacks to Pharmacy Benefit Managers, imposing pharmaceutical price controls, and mandating increased transparency for insurance companies.

In my book Pre-Existing Conditions: How Lobbying Makes American Health Care More Expensive, I show that some of these ideas have already been tried in the states, with varying degrees of success. For example, in 2017 the Nevada legislature passed a bill to increase the transparency of the pharmaceutical supply chain, including the kickbacks to Pharmacy Benefit Managers. But following heavy lobbying from the pharmaceutical industry it was vetoed by Republican Governor Brian Sandoval. This is a consistent pattern. Cost containment policies such as these are routinely defeated or diminished in a similar fashion across nearly all the states, by the same culprit: lobbyists representing the healthcare industry.