Just about everyone has heard the stories or encountered personally the outrages in prescription drug pricing. Martin Shkreli emerged as the representative man, or “robber baron,” when his company purchased an AIDS drug and hiked the price from $13.50 to $750 per pill.

Gilead purchased a hepatitis C drug from Pharmasset and proceeded to increase the price of the 12-week regimen from $36,000 to $84,000. This was a drug Gilead played little role in developing.

Double-digit price increases have been the pattern in recent years. Drugs account for an expanding share of overall health care spending, today roughly 17 percent, compared to 10 percent in 2014.

Surveys show many Americans struggle to cover the cost of prescription drugs. Add to the equation comparisons with other countries. A 2015 report by the Organization for Economic Cooperation and Development found the United States yearly spends $1,162 per person on drugs, while Germany spends $766, France, $668, and Great Britain, $497.

It follows that Ohio Taxpayers for Lower Drug Prices, the organization behind state Issue 2 on the November ballot, has the material to post its “Daily Drug Outrage.” It makes sense, too, that on first impression, the proposal seems right.

Why not strike a blow against the mighty drug industry? The issue requires the state to pay no more for drugs than the lowest price paid by the federal Department of Veterans Affairs. Why the VA? It enjoys a mandated 24 percent discount, and negotiates other price-reducing deals with drugmakers.

The trouble is, what appears simple enough gets complicated.

If that 24 percent is evident, the remaining reductions are not public. So it is hard to land precisely on the lowest price paid. The VA and the state operate differently. The state, for instance, makes much greater use of pharmacies, adding a level of distribution costs. Thus, any linkage becomes difficult to compute.

Consider that Issue 2 doesn’t cover two-thirds of Ohioans, including Medicare recipients and those with employer-based health insurance. In addition, Medicaid, which accounts for 75 percent of state spending on drugs, already receives a mandated 23.1 percent discount, with other reductions available.

So what would Issue 2 achieve?

Proponents argue that these and other factors can be overcome. The measure is an initiated statute. So state lawmakers could go to work seeking to get as close to the intent as they can. How eagerly would Republican lawmakers take up the task? They would see a torrent of lawsuits as drugmakers and others challenge any implementation.

Which appears to explain the unusual second element in the ballot language. It requires the state to pick up the legal fees of petitioners if they choose to intervene in a challenge to the law.

What gets too few mentions in this debate, certainly not in the many television ads, is that the problem of high drug prices isn’t something for a state to solve. Almost all of the action takes place on the federal level, the market national in scope, Congress writing the laws, regulators handling enforcement.

That is discouraging in a way, the drug industry with so much clout, strategically deploying campaign dollars, one tally finding two industry lobbyists for each lawmaker. Yet this is the venue for making a difference, as the lessons in drug pricing from other countries confirm.

How do they keep costs in check? They apply price controls, either directly or indirectly.

They do so by purchasing in bulk. In Canada, a national review board keeps tabs on drug pricing, barring excesses or what it deems as gouging. Other countries also negotiate deals essentially like the arrangements already here for veterans and Medicaid recipients.

In a December letter, U.S. Sen. Sherrod Brown and 19 colleagues urged President-elect Trump to move in this direction. They outlined five reasonable steps, including using the leverage of the federal government to negotiate drug prices for Medicare. They called for doing more to ensure the timely entry of generic drugs into the market.

There are stronger options, such as limiting television ads for drugs or tapping a 1986 law that invites applying the clout of the federal government in view of its role in supporting research and development. Drugmakers warn that messing with the system easily could put innovation at risk. Yet that doesn’t have to be so with a recasting of the partnership between the industry and the National Institutes of Health.

The president has sounded ready, even declaring that the drug industry is “getting away with murder.” He also has backed off. What Ohioans should take away is even some steady presidential jawboning promises more results than Issue 2.

Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514 or emailed at mdouglas@thebeaconjournal.com.