I don't think that the central issue on drugs is about importing. This
is certainly an important issue for the drug companies that have
exclusive access to the Medicare D program introduced by GW Bush in
2003. Amazingly, this is one of the few federal programs that does not
allow for competitive bidding. This single issue inflates drug prices
in the US and makes drug prices much lower in other countries that use
the purchasing power of their programs to drive prices down.
The history goes back to the Truman administration and illustrates why
health care legislation has been so difficult. You might enjoy a very
good history of this at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690175/
Briefly, coverage of drug costs was not included when Medicare was
finally introduced in 1965 because of concerns about the cost. It was
not until 2003 when Medicare D was introduced by the GW Bush that any
coverage was provided. Why then? Basically this relates to the battle
that raged between Democrats and Republicans over cost. The Democrats
fought to protect the "bill for service" approach used in Medicare A and
B while the Republicans fought to introduce Medicare C which limited
future cost liability with a fixed price per individual "managed care"
approach. Unfortunately, Medicare C was failing when GW Bush took
office. Something new was needed to salvage it and that something new
was Medicare Advantage which included drug coverage. The compromise
that the GW Bush administration made to make the bailout of Medicare C
seem less obvious was the introduction of Medicare D which opened drug
coverage to other Medicare plans, albeit at a cost. The most
controversial issue at the time was the absence of using the Medicare
market to force competitive bidding, a problem that continues to plague
us.
This issue carried over into the debates that raged over the ACA
(Obamacare). In order to get anything passed, the Obama administration
avoided tampering with the cash cow that the drug companies enjoyed.
The issue of building the ACA around a single payer system like Medicare
was ultimately abandoned by the House in favor of a public option. Let
the individual customers of insurance decide if they wanted private
insurance or government insurance. In the heat of this debate in the
Senate, drug coverage was at most a side issue that had already been
conceded. Ultimately variations of the public option were offered in an
attempt to save it including opt-in and opt-out proposals. It was Joe
Lieberman who put the final nail in the coffin for the public option. I
also blame Harry Reid who refused to change the Senate rules to allow a
majority vote, keeping intact the Republican strength in the filibuster.
I also fault Max Baucus who gave away his majority advantage in the
Senate Finance Committee by creating his infamous "Gang of eight" which
succeeded only in wasting a lot of time thereby allowing opposition to
build in the very public campaign by the health care industry to kill
the ACA over the summer of 2009. He could have brought the House bill
to the Senate floor in July and the public option would have been part
of the ACA.
The message in all of this is the massive influence that the industry
has on politicians including the Democrats that I mentioned above.