One of the challenges for conservatives trying to fix broken systems with proven free-market principles is when the system itself is so broken as to be impervious to the free market. How do we get choice, transparency, and competition into systems like Medicare and Medicaid that are virtual government monopolies?
A little over 20 years ago, the Bush administration tried this with Medicare Part D, which offered competing plans for seniors’ prescription drug plans to mostly successful results. The question is now, can we replicate the similar outcomes for the broader healthcare market?
How do we improve our healthcare system with transparency and market competition to lower costs rather than price controls which will end up doing more harm than good in the long run?
Enter TrumpRx, which enables Americans to purchase medicines at the best prices, without costly markups driven by payers and middlemen. The business models of these intermediaries in our health system rely on rebates, fees, and incentives that rarely reach the patient. Moreover, American patients have long borne the hidden burden of effectively subsidizing prescription drug costs for foreign health systems, while paying far more for the same medicines here at home. Up to 26 percent of consumer-facing drug prices in the U.S. are spent covering costs for foreign nations that are freeriding off American innovation.
That dynamic is now being challenged by the common-sense, market-oriented reforms anchored by recent deals between the White House and major pharmaceutical manufacturers.
Enabling direct drug purchasing at competitive rates reduces inflated prices, eliminates layers of unnecessary markup, and increases access for Americans who rely on prescription medicines to improve their quality of life and stay productive. TrumpRx puts power back where it belongs — with the consumer.
This isn’t bureaucratic price-setting, it’s simple market discipline. 50 cents of every dollar spent on medicines in the U.S. goes to insurers, hospitals, and others in the supply chain — driving up out-of-pocket costs for American patients. By cutting out these layers of markup, pharmaceutical manufacturers can sell medicines at or near what other advanced countries pay. For Americans, this translates into real savings, improved access, and greater transparency.
At the same time, there remains a real threat around embracing overly broad, one-size-fits-all drug pricing approaches, such as “Most Favored Nation” (MFN), across the prescription drug market. Without a considered approach, broad MFN pricing risks undermining innovation, discouraging new drug development, and distorting global pricing in ways that could ultimately hurt patients — both at home in America and abroad.
Unlike direct-to-consumer options, MFN could mask price-distortion rather than fix the root causes of high costs for patient, lack of transparency in supply-chain costs, and perverse incentives that inflate list prices well beyond manufacturing costs.
When our government tries to micromanage prices at scale, the long-term cost is always paid in diminished innovation, fewer choices for consumers, and less competition in the marketplace. MFN cannot be treated as a quick fix without considering the negative consequences on American industry, innovation, and patients. What the United States actually needs — and what TrumpRx begins to deliver — is competition, transparency, and choice.
By advancing a direct-to-consumer model, TrumpRx gives American consumers the ability to access the treatments they need, when they need them — without subsidizing access for other countries.
Herein lies the real test for other players across the healthcare supply chain. If insurers and other intermediaries continue to resist such models or insist on using opaque practices that fail to share savings with patients, they will only undermine the benefits that TrumpRx delivers and make life harder for the patients they claim to support. If manufacturers can come to the table with the White House for the benefit of patients, why can’t other players in our health system do the same?
Conservatives have long championed markets, individual choice, and limited government intervention — but it’s been difficult to work those principles into a government monopoly. TrumpRx aligns with these principles: it is a pro-consumer, pro-market reform that gives power back to patients. It reduces reliance on intermediaries, discourages price-gouging, and restores market discipline — without resorting to heavy-handed regulation or bureaucratic price-controls.
The Trump White House has succeeded where predecessors have not — advancing meaningful reform that can improve access and lower costs, while keeping American leadership in pharmaceutical innovation alive. It reminds one of Teddy Roosevelt’s New Nationalism, but for the digital age.
As the never-ending healthcare debate continues in Washington, the right approach is coming into focus: the future of American healthcare will be shaped not by the heaviest hand of government, but by reforms that trust patients to manage their health, reward innovation, and demand accountability from every player in the system.
Jared Whitley is a longtime politico who has worked in the US Senate, White House, and defense industry. He has an MBA from Hult business school in Dubai, and in 2024 he won the Top of the Rockies best columnist award.