Los Angeles Times columnist Michael Hiltzik recently took on the "drug money" against a November ballot measure to require the state to pay the lowest price available for prescription drugs, which is the Veterans Administration prices. 
 
Drug companies have put up $100 million against the effort by the AIDS Healthcare Foundation to rein in state drug costs. 
 
There's some déjà vu.  In November 2014, the lowest turnout election in California history, Capitol Watchdog's publisher Consumer Watchdog spearheaded two unsuccessful ballot measures against more than $100 million in opposition from the medical insurance complex. 
 
So how much will the drug money matter in 2016?
 
A higher turnout presidential election is likely to bring a much more progressive electorate than in 2014.  Latino registration is up in the first months of this year in the double digits. That's good news for David in this fight. The more sympathetic the voters, the harder it is to scare them.  Prop 45, our health insurance rate regulation that secured 41% of the vote, was slated for the 2012 presidential ballot but a signature counting issue delayed it for a nonpresidential election. 
 
$100 million also works against the spender if you are the drug industry and the public learns you're behind the opposition.  Why would the drug industry spend $100 million against a ballot measure if it wasn't good for consumers?
 
With more than a dozen ballot measures expected to be on the ballot, and most big money battles, this is expected to be a very noisy year. $100 million will make it noiser, but whatever drug companies spend may not be enough to carry a breakthrough message.   
 
The pharmaceutical industry's playbook is well worn, but it's also been effective. Here's how it goes:
 
A. Daze and confuse.  The industry's going to seed a lot of doubt. Prop X says one thing but does another is the oldest initiative killer in the book. The committee against the measure is not surprisingly called "Californians Against the Misleading Rx Measure."  Of course, if you are the drug companies, whose public approval rating is only slightly higher than rapists, you have to find another messager so ……
 
B. Hide behind a white coat.  Doctors have proven the best cover for drug companies. Expect lots of physician experts standing in front of the doors of top hospitals or medical schools claiming that the proposition won't do what it purports to and will actually make medicine worse.  
 
C. Cover your tracks.  There will be a long list of opponents, the best money can buy, but you won't see the real source of the $100 million displayed prominently.   One old favorite of  Pharma is, for example, "The Senior Advocates League"  This is the same rent-a-senior group that was paid by the drug companies to support the drug company’s Prop 78 in 2006. It also surfaced for the insurance industry to try to stop implementation of voters' regulatory ban on zip-code based auto insurance in 2005 when Insurance Comissioner Garamendi finally delivered on rules to implement Prop 103’s ban (only state in America to have). And the League has played in legislative electoral races to back Chamber of Commerce candidates. See the League's history of entanglement in a ConsumerWatchdog.org search result. 
 
D.  Woo credible opinion leaders, like editorial boards, and bombard the public with their opposition via mail, tv, radio and every screen available to the eyes.  The drug company initiative could rise or fall depending upon whether it has the support of credible opinion leaders. In an age of noisy air and confusing screens filled with campaign pitches, the opinon leading establishment has outsized power as voters look for "credible" sources. To the degree that drug companies throw their money and power around to leverage opinion leaders and news outlets, afterall they will be big clients for the media, and the media allows Big Pharma to hide and coverup, the initiative could hang in the balance. If opinion leaders lay out the facts,  then drug companies will have a hard road ahead to win the public's trust.  No measure is perfect, without an Achilles Heel, but the question is whether this measure is right for California and history in the balance.
 
Underscoring the historic nature of the fight, Bernie Sanders was on CNN last night speaking live to a rally in Carson and singing the praises of the ballot measure as a panel of CNN undertakers debated the timing of his entombment as a candidate.
 
Increasingly, state and national press are play-by-play announcers, covering significant social issues as if they are sports writers. This isn't sport. The principles at stake in this ballot measure go to the heart of whether bulk purchasing in California and Medicare are valid, and to the much needed cost controls on the health care system which will be the next evolution of health reform. The editorial boards and opinon leading establishment will need to take some inventory of how they do their business and what the significance of this measure for the state and country truly is.