no mystery with this one:

but the effect is not as simplistic as it's often made out to be:

To proponents, defeat after defeat speaks solely to the power of the pharmaceutical industry and its attendant lobbyists.

But opponents say it reflects the complexity of the issue. Once lawmakers realize they could actually secure government price negotiations, they see how problematic that could be.

“If anyone thinks this is the easy political route for me, that’s just laughable,” said Mr. Peters, who has endured scorn and pressure from his Democratic colleagues but whose San Diego district includes almost 1,000 biotechnology companies and 68,000 jobs directly tied to pharmaceutical work.

Mr. Schrader and Mr. Peters said the House version of prescription drug price controls, tucked into the broader social policy legislation, would stifle innovation in one of the country’s most profitable global industries.

The Pharmaceutical Research and Manufacturers of America, known as PhRMA, also maintains that government negotiations would severely limit the types of prescription drugs that would be available to Medicare beneficiaries as companies withdraw their products from the program. With the good will the industry has accrued with its coronavirus vaccines and treatments, drug companies have pressed their case with key lawmakers, and roped in the larger business community.

I know for a fact that the reason many seniors are going bankrupt is that the brand name drugs their doctors say they need are either denied under their Part D drug plan (which in themselves have expensive premiums with complicated rules that can end up costing a lot out of pocket), or have extremely high copays for anything but the very basic old time generics.

The whole Medicare Drug Plan situation is a complex mess of price regulation already as each insurer has a formulary that the negotiate low prices for with the manufacturers and if you need something else it's bascially fuck you unless you can enlist your doctor to fight for an exemption for you. Few doctors will do this anymore, they absolutely despise having to go through the lengthy process taking much time away from other duties. There is actually a doctors lobbyist group that is fighting to do away with what's called "prior authorization", which is merely a simple first step in insurers challenging doctors to support their choice of drug that is more expensive for the insurer.

If Medicare was handling this as a single entity, certain drugs would simply be denied if they would not come down on price and the insured would have to pay the asking price of the manufacturer out of pocket. Right now it is the case that smart seniors with a lot of time on their hands can shop for an insurer that will cover the cost of what they need at annual enrollment time. And dumb seniors are screwed.

It is true that we are paying high prices for new drugs for research and innovation in drugs for the benefit of the rest of the world that regulates prices and doesn't approve paying for those new drugs.

I have a quibble with this spin. I don't think they all want to "protect wealthy tax cheats". They don't want to be forced to get into the business of reporting possible income to the Federal government (a deposit to an account is not necessarily taxable income.) They think someone else should be responsible for that, like the person with the income: