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"they explicitly rule out negotiating the best rate for pharmaceuticals? We've every right to be outraged about that part, at least.."

Yes, imag. We know the veterans adminstration is able to negotiate rates with drug suppliers and does quite well with it.

We also know that Hillary Clinton's effort to reform health care last time around was defeated by a massive multi-billion dollar ad/lobbyist program from the drug/insurance/healthcare industry.

You can defeat an entrenched lobby only with strong grass roots support.

In crafting the Part D coverage, Congress was mindful of the possible opposition of those same interests and crafted a law they could support. Changing some of those provisions might be possible in time, but I don't think it will be easy.

These are typical practical minded politics. Compromises are made to get the necessary votes. Some terrible. Some not too bad. This one is at least functional. And in return for premiums it does save many of the elderly some money on their drug costs.
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