Polling tells us that when it comes to health care issues, the top priority of Americans is lowering prescription drug prices. While this remains a divided country on many issues, there is absolute unity on the question of how to achieve this particular goal.

Eighty-eight percent of all Americans surveyed in May by the KFF Health Tracking Poll expressed support for a Democratic plan to allow the federal government to negotiate lower prices on medications. Seventy-seven percent of Republicans, 89 percent of independents, and 96 percent of Democrats favor the plan.

A West Health/Gallup survey in June put the level of Democratic support for the proposal at 97 percent, and announced that “nearly all Democrats…support empowering the federal government to negotiate lower prices of brand-name prescription drugs covered by Medicare.”

Since polls have margins of error, it’s reasonable to speculate about whether any grassroots Democrats oppose using the power of government to cut drug prices.

Unfortunately, a handful of congressional Democrats do oppose acting on the issue. Because Democrats control the House and Senate by narrow margins, this opposition threatens necessary reforms. If that threat becomes a reality, it could doom Democratic prospects for retaining control of Congress in 2022.

President Biden acknowledged as much in his inaugural address, saying, “This is certain, I promise you: We will be judged, you and I, by how we resolve these cascading crises of our era.”

That judgment will be harsh if Democrats fail to deliver on an issue so broadly popular as lowering drug prices.

Yet, when the House Energy and Commerce Committee reviewed a proposal for government negotiations to lower drug prices, three Democrats—Kathleen Rice of New York, Scott Peters of California, and Kurt Schrader of Oregon—voted “no.” Their votes, in combination with Republican “no” votes, created a tie that blocked approval of the reform by the key committee. Politico observed that the trio “threw their party’s health care agenda into disarray.”

While things may get sorted out in the House, circumstances in the Senate took a turn for the worse on September 15, when Arizona Democrat Kyrsten Sinema reportedly informed Biden that she’s opposed to the drug-price reform proposals that Democrats ran and won on in 2020.

Sinema’s resistance to the drug reform component of the Senate budget reconciliation bill, in combination with the more generalized rejection of the measure by West Virginia Democrat Joe Manchin, has inspired speculation about whether Biden might be forced to accept a deep cut in the $3.5 trillion proposal—which, as outlined by Senate Budget Committee chair Bernie Sanders, relies on funds saved by negotiating lower drug prices to pay for Medicare expansion.

Biden met with congressional Democrats on Wednesday in hopes of keeping things together. But Politico reports that the latest moves by the Arizona and West Virginia senators—who so frequently combine to upend the party’s plans that they’ve come to be referred to as a single entity, Manchinema—have “cast significant doubt on Biden’s ability to get the votes to pass his signature domestic initiative.”

That’s bad news for the tens of millions of Americans who would benefit from drug-price reductions, and terrible news for the hundreds of millions of Americans who would benefit from the passage of the reconciliation bill—which features proposals to provide dental, vision, and hearing care under Medicare, to guarantee paid family and medical leave, to provide affordable day care for working parents and to make community college free.

It’s also bad news for Democratic political prospects. If President Biden and his congressional allies do not deliver on promises made in the 2020 election cycle that gave them control of the White House and the House and Senate, Democratic prospects for keeping control of Congress in 2022 will undoubtedly be harmed. Mobilizing the high turnout of irregular voters that the party needs was always going to be hard in a midterm election—and it will be even harder if frustrated Americans find themselves asking, “What’s the point of electing Democrats if nothing changes?”

Why would any Democrat put at risk their party’s ability to govern boldly, and in so doing make easier the work of former president Donald Trump and the Republicans who are maneuvering to regain power in 2022 and 2024?

The answer has everything to do with Big Pharma’s big bankroll. Says Sanders: 

While millions of Americans cannot afford the outrageous price of prescription drugs, pharmaceutical companies are making obscene profits and paying their executives exorbitant compensation packages.

Last year alone, the six largest drug companies in the U.S. made nearly $50 billion dollars in profits, while the ten highest paid pharmaceutical executives made over $500 million dollars in total compensation.

And what does the pharmaceutical industry do with these profits?

Well, over the past 20 years, they have spent over $4.5 billion on lobbying and hundreds of millions of dollars in campaign contributions. They employ nearly 1,500 lobbyists in Washington, DC alone—including the former congressional leaders in both major political parties. Got that? That’s almost three prescription drug lobbyists for every Member of Congress.

The bottom line, says Sanders, is that “the prescription drug industry, through their wealth and their power and their ability to bribe Members of Congress with massive campaign contributions, can get away with ripping-off the American people by charging whatever outrageous price that the market will bear for prescription drugs.”

This is bipartisan bribery. Millions of dollars flow from pharmaceutical industry-aligned donors to Democrats. Many of those Democrats still support regulating the industry, but those who refuse to do so have become a major headache for Biden.

Sinema has, during the course of her congressional career, collected $519,238 from the pharmaceutical and health products industries. In the last year alone, individuals and PACs associated with Big Pharma have donated $398,697 to her campaign committee—a striking figure, considering that she’s not up for reelection until 2024.

Manchin has, during his Senate career, collected $506,265 from pharmaceutical interests—including $199,015 so far in the 2022 cycle, despite the fact that, like Sinema, he won’t be on the ballot until 2024.

The three House Energy and Commerce Committee Democrats who voted with the industry have taken in a combined total of more than $1.5 million in Big Pharma–linked contributions. Peters, who represents a solidly Democratic San Diego–area district, has been raking in the cash, inspiring headlines like “Pharma CEOs, lobbyists showered Democrat with cash after his attempt to torpedo Pelosi’s drug pricing bill,” and “This Democrat got big money from Big Pharma—and turned against lower drug prices.”

Amid speculation that Peters and the Democratic Party’s Big Pharma Caucus might ultimately tank legislation that could secure lower drug prices, Sanders says, “I understand that the pharmaceutical industry owns the Republican Party and that no Republican voted for this bill, but there is no excuse for every Democrat not supporting it.”

There is no excuse. But there is an explanation.

Big Pharma doesn’t discriminate when it buys politicians. It buys a lot of Republicans, and just enough Democrats to tip the balance against Americans who cannot afford the drugs they need to survive and thrive.

That’s a bad moral calculation for all the politicians who accept Big Pharma money. But it’s an especially bad political calculation for Democrats.

If Joe Biden, Chuck Schumer, and Nancy Pelosi fail to pull compromised Democrats out of the clutches of Big Pharma, they will not be able to secure drug-price reforms that are enormously popular—and crucial to paying for the expanded benefits voters are clamoring for. And if Democrats cannot deliver the changes that voters gave them the power to enact, there’s a good chance they will lose that power in the next election.