Americans are notoriously unhappy with healthcare. As of last December, Americans’ perception of the quality of US healthcare hit a new low, with 54% of the population reporting to Gallup that quality is either fair or poor. Coverage is viewed even more poorly than quality, and it has slowly brought the Republican Party of President Trump to a position where their message is identical to that of socialist Senator Bernie Sanders. President Trump began the week by tearing into American pharmaceutical firms, accusing them of “profiteering and price gouging”.
No healthcare system is perfect, but in America, it could get noticeably worse as the administration attacks on at least four fronts. What’s at stake is a system that does incredibly well at facilitating medical innovation and access to new lifesaving drugs.
The first battle front is President Trump’s freshly announced executive order that would limit the price Medicaid pays for drugs to what ‘most favored nations’ pay for the same drugs. This could trigger a tectonic shift for drug availability in the US and overthrow the business models of the pharmaceutical and biotech industries. Politically, it’s an easy position to take, especially after the public approval hit these sectors took post-COVID pandemic.
Companies would be encouraged to reduce research and development spending for future drugs, which would leave patients of tomorrow with drugs of the past. There’s a reason America sees so many new pharmaceutical ads every year, and it's because the industry is in constant motion.
The second front is within the Health and Human Services Department (HHS) and the Food and Drug Administration (FDA), where rapid-fire leadership changes have cast doubt over how committed these institutions are to issuing approvals and reviewing new cases promptly. Things have slowed down dramatically within the FDA. Secretary Kennedy doesn’t appear to have any problem with this, thus his move to put healthcare influencer Casey Means into consideration for Surgeon General.
The third front is within Elon Musk’s Department of Government Efficiency (DOGE), which directly or indirectly led to 3,500 FDA staffers departing the agency. While US patients need an efficient agency, and there’s undoubtedly a good amount of waste happening in government bureaucracies, this large cut at the FDA comes with unintended consequences that cut against the interest of patients.
Biotech companies are already complaining about confusion at the agency and struggling to find the right point of contact for clinical trials. In addition to slowdowns, American patients are deprived of the chance to enroll in clinical trials for new medicines. Those will likely start being moved overseas, where firms won’t have to worry about their case manager being “DOGE’d”.
The final front of disruption coming from President Trump’s White House is the ongoing trade war and tariff escalation. Pharmaceuticals require ingredients, and very often those are coming in from overseas.
The U.S. Department of Commerce just recently started a probe to develop potential tariffs on drugs and their components. This measure aims to bring more pharmaceutical production to the United States, but at least in the short term, it would increase drug costs for Americans. Don’t expect much fanfare when those price points rise.
Tariffs on drugs, delayed research on cures, and punitive pricing of medicines aren’t a fix for the system that Americans so clearly want improved.
The Trump Administration should look at innovative ways to improve US healthcare, such as allowing reciprocal approvals of drugs, basically considering approvals based on what European and Japanese authorities greenlight. Trump can also slash all tariffs and non-tariff trade barriers for pharmaceutical products.
Getting healthcare and research right is a matter of life and death for patients in the most need. It’s good to see an administration willing to challenge convention and shake things up, but that energy is being pointed in the wrong direction.
