This hardly seems important at the moment, but Sarah Kliff mentioned something today that's always bugged me. She's explaining why prescription drugs cost a lot more in the US than elsewhere, and concludes that it's because other countries all negotiate drug prices at a national level and we don't:

The United States has no government panel that negotiates drug prices. There are thousands of health insurance plans all across the country. Each has to negotiate its own prices with drugmakers separately. Because Americans are fragmented across all these different health insurers, plans have much less bargaining power to demand lower prices. In other words: Australia is buying drugs in bulk, like you would at Costco, while we’re picking up tiny bottles at the local pharmacy. You can guess who is paying more.

OK, but take a look at the stick figure on the right, part of Vox's latest innovation in explanatory journalism. The country with the lowest drug spending is Denmark, population 6 million. Compare that to Blue Cross, which insures about 100 million people. United Healthcare insures about 70 million. Aetna insures about 20 million. Kaiser Permanente clocks in around 10 million.

In other words, all of these health insurers are as big as whole countries. And they're way bigger than little Denmark. So why are they unable to negotiate lower drug prices? Medicare may be prohibited from doing this, but private insurers aren't.

Are insurers hemmed in by rules requiring them to offer any "medically necessary" drug? Are they, ironically, limited by competition—afraid of losing customers if they don't cover everything? Are they just lousy negotiators because they don't really care? After all, high prices are going to get passed along anyway, so it doesn't hurt them as long as their competitors are in the same boat.

Alternatively, do I completely misunderstand how the process works?

My gripe with this is not so much that drug prices are high. My gripe is that the US essentially subsidizes the rest of the world. Pharmaceutical companies require a certain overall return on their invested capital, but they don't care where it comes from. If prices are low in Europe and high in the US, that's fine. If prices in the US came down, they'd make up for it by raising prices in Europe—and that would be fine too.

So why not put America First, to coin a phrase, and push down prices here? It wouldn't hurt the drug companies, it would just force them to raise prices elsewhere. That would be fine with me. I've never really understood why we're in the business of helping Europe pay less for drugs.

This is insane:

A top Russian official is accusing the Ukrainian government of undermining Donald Trump’s presidential campaign by trashing him on social media and disseminating dirt on one of his close associates.

....“Ukraine seriously complicated the work of Trump’s election campaign headquarters by planting information according to which Paul Manafort, Trump’s campaign chairman, allegedly accepted money from Ukrainian oligarchs,” Maria Zakharova said at a press briefing....The renewed scrutiny of Manafort’s dealings in Ukraine comes at an awkward time for the veteran operative and for Trump.

WTF? Russia is publicly complaining that another country took sides against it in an American election? Aren't they even pretending anymore that they didn't do anything to help Donald Trump win the presidency?

One of the problems with Donald Trump's habit of lying endlessly—aside from the fact that he does it in the first place—is that it affects everyone around him. By chance, today brought this all front and center. We start off with Trump himself:

This is a routine, garden-variety Trump lie. He obviously knows it's untrue, but he doesn't care. You see, for him it represents some kind of higher truth. Trump lackey Scottie Nell Hughes, in the course of explaining a different Trump lie, tells us how this works on the Diane Rehm show this morning:

People that say facts are facts, they're not really facts....There's no such thing, unfortunately anymore, as facts. And so Mr. Trump's tweet, amongst a certain crowd, a large part of the population, are truth. When he says that millions of people illegally voted, he has some facts amongst him and his supporters, and people believe they have facts to back that up. Those that do not like Mr. Trump, they say that those are lies and there's no facts to back it up.

Got that? These things the rest of us call lies are facts amongst him and his supporters. Senior lackey Kellyanne Conway agrees that truth in Trumpworld is a relative thing, but defends it more directly. If Trump says it, then by definition there must be something to it:

Finally, Corey Lewandowski tells us all to just get the hell over it:

This is the problem with the media. You guys took everything that Donald Trump said so literally. The American people didn’t. They understood it. They understood that sometimes — when you have a conversation with people, whether it’s around the dinner table or at a bar — you’re going to say things, and sometimes you don’t have all the facts to back it up.

Apparently we've got four years of this behavior ahead of us. Trump's "facts" aren't meant to be facts. They just represent a state of mind, or perhaps an aspiration of some kind. His supporters all get this. Now we'd all better get it too.

This popped up in my Twitter feed this morning:

This is totally true. Yesterday I noted that Bernie Sanders had urged Trump to deny federal contracts to companies that move jobs overseas, which I called a massive abuse of power. I got some pushback on that, along the lines of "Why shouldn't a president stand up for American workers?"

Well, a president should. But a president shouldn't personally punish companies that do things he doesn't like. I hope that requires no explanation. Now, if Congress passes a law banning federal contracts for companies that engage in some specified form of job offshoring, that would be different. It would almost certainly be a very bad law, but I'm pretty sure it would be constitutional. And if it allowed the executive branch a certain amount of discretion in enforcing the law, then Trump could take advantage of that.

I would not recommend doing this. But it would be legal. Until then, however, it wouldn't be. And it would be wrong. Let's not encourage Trump to think of himself as any more of a mafia kingpin than he already does.

Big Mac Followup

I got showered with comments yesterday about the Big Mac. It's so much more than the middle bun, you cretin! Even my sister got on my case about it. My sister!

So today I went out to our newly refurbished McDonald's and got one. My conclusion: it was fine. The special sauce was fine, the pickles were fine, and it was a perfectly good hamburger on the McDonald's scale of hamburgers. About halfway through eating it, though, it suddenly occurred to me that...it sure had a lot of bread. But all of you Big Mac lovers like the extra bun, I guess. De gustibus.

I haven't been to McDonald's in a long time, and I see that they now hand out numbers like most other places. Unlike other places, however, mine has a staff that comes by and takes your number from the table without leaving any food. It took a while to sort this out, so I used the time to load Facebook on my phone. I did this because apparently blog posts with inline images (like the one on the right) don't render very well in Facebook Instant, whatever that is. And since half our traffic now comes from mobile Facebook users, this is a problem.

So I got the Facebook app loaded and then scrolled through my feed, but there was nothing of mine there. Hmmm. I've never paid much attention to Facebook, so I wasn't sure what to do. I searched for MoJo, and then liked it, figuring that might make MoJo content appear. Oddly, though, what it mostly did was make lots of Brad DeLong posts appear. What's going on up there at Cal? I got this sorted out eventually, but it turns out the MoJo digital team has been curating the feed so that the troublesome posts don't go up. So I still don't know quite what's going on. But I'll find out soon enough when I chat with our web folks.

That was my midday. How was yours?

The Washington Post says Donald Trump will pick Gen. James Mattis as his Secretary of Defense. I gather Mattis is pretty well respected, though I continue to believe that Trump himself was swayed solely by his "Mad Dog" nickname.

Mattis will need a special exemption from Congress, since he's only been retired from the military for three years rather than the legally required seven. That will probably sail through, though I sort of hope it runs into at least a few bumps. I don't have anything against Mattis, but the 7-year rule is a pretty good one. Civilian control of the military is an important tradition.

According to Paul Ryan, he has six top priorities for the upcoming year:

Regulatory relief....Obamacare relief....reforming the tax code....foreign policy, rebuilding the military....securing the border....And then while we work on that, we want to work on poverty and restoring our constitutional separation of powers....So those are effectively the six pieces that we’ve been talking about.

I have a couple of comments about this. First, there's nothing here about entitlement reform, or Medicare reform in particular. This doesn't mean Medicare is safe forever, but it does suggest it's not a briar patch Ryan wants to jump in right away.

Second, these are all really, really complex. Regulatory relief—whatever that actually means—is dauntingly complicated. Repealing Obamacare is all but impossible without Democratic support, which means months or years of negotiation. Tax cuts are easy, but Ryan seems to want wholesale tax reform on the 1986 model, which has a ton of moving parts. Securing the border is a lot more than just building a wall. And "working on poverty"—I shudder to think what he means by this—is obviously no cakewalk.

On the bright side, rebuilding the military is fairly easy. You just give them more money and hope it doesn't go down a rat hole.

If Ryan is serious about this stuff, he's mapped out two years of work already—and that's not even counting whatever Donald Trump wants to throw in the mix. Put it all together, stir in Trump's promise not to touch entitlements, and I suspect that we're not going to see any serious movement on Medicare for at least a year, maybe more.

The Wall Street Journal passes along the latest news on the Carrier deal:

Indiana officials agreed to give United Technologies Corp. $7 million worth of tax breaks over 10 years to encourage the company’s Carrier Corp. unit to keep about 1,000 jobs in the state, according to people familiar with the matter....The deal would cover 800 Carrier workers from the Indianapolis furnace plant and an additional 300 research and headquarters positions that weren’t slated to go to Mexico, according to another person briefed on the deal.

Two things. First, we're now down to 800 jobs saved. The other 300 weren't going to Mexico in the first place, while another thousand are still scheduled to head south of the border. Second, this comes to about $1,000 annually per job saved. As these kinds of deals go, that's not too bad.

However! Keep your eyes open. Call me cynical if you want, but I have a feeling it might eventually turn out that Carrier got a few more tidbits out of Trump than just this.

Back in October, when Democrats were in charge of the White House and seemed set to continue that, 32 percent of Americans said they wanted to repeal Obamacare. After the election, when Republicans had won total control of everything, that number dropped sharply to 26 percent. Here are the results of the latest Kaiser tracking poll:

Apparently, when repeal of Obamacare became a concrete reality, rather than just a rallying cry, a fair number of people started to think twice. Even among Trump voters, only half want to see the law repealed.

In any case, Democrats have a secret weapon to rescue Obamacare—one that's hiding in plain sight. More on that later.