When President Trump signed Executive Order 14297 earlier this year, dramatically titled “Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients”, it came with all the spectacle and self-congratulation we’ve come to expect. The promise was bold. Americans, he declared, would no longer pay more for prescription drugs than people in other countries.
That headline was easy to sell. Who wouldn’t want lower drug prices, especially in a country where patients routinely skip lifesaving medications because they can’t afford the cost? But like so many things with this administration it turns out the devil is in the details, and this particular devil is wearing a mask of benevolence while quietly sharpening its claws.
At the heart of the order is a concept called “most-favored-nation” pricing. It sounds like a good deal. Why should the U.S., arguably the richest nation on Earth, pay more for drugs than France, Germany, or Canada?
The logic, on the surface, is seductive. We’re told that our bloated prices are the result of other countries “freeloading” off American innovation, paying far less for the same drugs. The executive order is supposedly about ending that unfairness and about sticking up for American patients. Finally telling Big Pharma: enough is enough.
But that’s not really what this is about.
The key language buried in the order reveals its true purpose, to pressure other nations to raise their prices. Not to lower ours. Not to regulate price gouging. Not to negotiate directly with drug companies for better deals like other nations already do. No, this is about bullying other governments into paying more, so we don’t feel so ripped off.
Here’s the core truth that often gets lost in the rhetoric. Other countries pay less because they negotiate harder. They treat health care as a public good, not a profit center. Their governments cap prices, buy in bulk, and reject drugs that don’t offer value. They use the power of the public purse to say, “No, that’s too expensive.”
We don’t do that here.
In the United States, Medicare is legally barred from negotiating drug prices. That’s not an accident, it’s a feature of a system designed by lobbyists, for lobbyists. Drug companies have made billions off our refusal to act like grown-ups at the bargaining table. We don’t get better drugs. We just get more expensive ones.
So what does Trump’s executive order do? It doesn’t lift the ban on Medicare negotiation. It doesn’t rein in price hikes. It doesn’t even have the force of law. It’s a threat, more bark than bite, telling drug companies and foreign governments, “Play ball, or we’ll make you.”
Let’s be clear. This is trade policy masquerading as health reform.
Rather than fix the rigged system at home, the administration is trying to force other countries to fix their “problem”, which is to say, the fact that they’ve successfully kept costs down. And don’t be surprised, if those countries do start paying more, that the pharmaceutical industry will use that to justify not lowering U.S. prices. After all, they’ll say, everyone’s paying more now. Why should we slash prices?
And that’s the dirty little secret. This isn’t about fairness. Iit’s about preserving profits.
It’s not just speculation. Trump’s order specifically instructs the U.S. Trade Representative and Commerce Department to “address foreign free-riding.” In plain English, that means pressuring foreign governments to abandon their own price controls so that American pharmaceutical companies can boost revenue overseas.
That’s a win for Big Pharma. It’s not a win for American patients.
The executive order gives drug manufacturers 30 days to “voluntarily” comply before regulatory action is considered. But what does voluntary mean when there are no consequences for ignoring it? It’s like putting a speed limit sign on the Autobahn, just for decoration.
Even if rulemaking follows, the industry will tie it up in courts for years. And the order only applies to certain Medicare programs, not the private insurance plans that most Americans use. So even if it were implemented perfectly the effect on the average American’s out-of-pocket costs would be modest at best.
If we’re serious about bringing down drug costs we need real reform. That means letting Medicare negotiate directly with drug companies just like the VA does. Capping out-of-pocket costs for essential medications like insulin. Enforcing transparency in pricing and research funding. And yes, breaking the cycle of regulatory capture that allows industry lobbyists to write public health policy.
But that would take courage. It would mean going up against the multi-billion-dollar pharmaceutical lobby. It would mean telling campaign donors no.
So what we get is theatrics.
Worse still, this policy risks harming patients in other countries. If the U.S. succeeds in forcing price hikes abroad poorer nations could be priced out of basic medications. Access could shrink. Health outcomes could worsen. And global public health, already strained by pandemics and climate change, would suffer for the sake of American optics.
That’s not leadership. That’s extortion.
In the end Trump’s drug price executive order is classic political sleight-of-hand. It promises justice but delivers justification for more profiteering, more nationalism, more posturing. It’s not about what patients need. It’s about what the market wants.
If we’re going to talk about fairness, let’s be fair. No one should have to choose between medication and food. No one should be bankrupt by cancer. And no one should mistake a press release for policy.
This order might sound like progress. But if you peel back the layers it’s not a ladder up. It’s a mirror showing us a broken system, and the lengths we’ll go to avoid fixing it.
Disclaimer: Jim Powers writes Opinion Columns. Views expressed in this editorial are my own and do not necessarily reflect those of Polk County Publishing Company or its affiliates. In the interest of transparency, I am politically Left Libertarian.
