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Fools Gold: The Mirage of the Public Option
The public option is a fantasy solution for real healthcare problems that only single payer can solve.
Nov 02, 2026
Americans are discouraged about the state of healthcare in the United States. The “Public Option” has again emerged as a possible solution to our healthcare woes.
What Is the “Public Option”?
There are several different proposals labelled as being “the public option” but, at its core, the public option is a health insurance plan that would be placed side-by-side and would also compete with commercial health insurance offerings, for example on the Obamacare exchanges. While the “public” in public option suggests a Medicare-type administration structure, the public option in some formulations would actually be administered by private insurers.
The public option stands in stark contrast to single-payer plans which cover everyone and eliminate private insurance plans entirely. Single-payer plans are often termed Medicare-for-All and, critically, are based on Medicare rather than on Medicare Advantage plans which tend to be run by private insurers.
Healthcare 2026
Americans had already been dissatisfied with the affordability of health insurance and healthcare in recent years, but the passage of H.R. 1, the “One Big Beautiful Bill Act,” has brought additional pain to Americans. This is due, in part, to the failure of H.R. 1 to extend healthcare subsidies that had previously been in place for individuals and families in the Exchanges. The full toll of H.R. 1 is not yet visible, but marketplace enrollment has dropped in 41 states. For example, North Carolina and Ohio saw declines of 22% and 20%, respectively.
Who Is Exploring or Promoting the Public Option?
Washington state and Colorado have both created public option experiments, and these experiments have not been very successful in lowering premiums or enrolling significant numbers of people.
Democratic politicians (including Washington Sen. Patty Murray) have touted the public option. Presidential candidate Joe Biden, an opponent of single payer, floated the public option. There is a center created at Georgetown University in 2022 with the explicit option of assisting policy makers in exploring the public option. A number of conservative groups have urged Republican legislators to support the creation of the public option.
How Can We Judge Plans for Healthcare Reform?
Reforms aimed at reversing the healthcare in the US can be judged by examining the extent to which plans fulfill the following criteria: Does the proposed solution
- Cover everyone;
- Lower costs;
- Reduce healthcare disparities; and
- Enable negotiations for healthcare necessities, such as pharmaceuticals?
Would the public option work?
Based on the four criteria outlined above, the public option fails to provide meaningful reform.
- Covering Everyone: The public option would not automatically cover people who are presently uninsured. More people could be covered if and only if the system would be economically sustainable. There is a real risk that private insurers could divert high-cost patients to the public option thus increasing, over time, the challenge of funding the public option. The vulnerability of the public option to adverse selection could cause the public option to enter a financial death spiral.
- Lowering Costs: The public option leaves the current commercial health insurance system in place, and thus a key driver of costs in our current system would remain completely unaddressed. Health insurance plans have much higher administrative overhead (12-18%) than classic Medicare (2%).
- Reducing Healthcare Disparities: Because the public option would merely add another insurance plan to an already complicated medical landscape and because the public option won’t cover everyone, it is unlikely that access and disparities would be effectively addressed.
- Enabling Negotiations: Pharmaceuticals are presently key drivers of healthcare costs. This is, in part, because prices for drugs are controlled by for-profit companies, beholden to shareholders, who have free rein to set prices. In order to have the necessary leverage to force pharmaceutical companies to negotiate, a plan would have to cover all or most US residents. Polls show that Americans would be enthusiastic about this aspect of single-payer plans, even if it would eliminate most private insurance and raise taxes.
Health insurance companies provide NO actual healthcare services on their own. The widely accepted theory is that these companies control healthcare costs by means of gatekeeping, but these companies actually add to healthcare costs by creating an expensive insurance workforce that Americans pay for with premiums. Private insurance also installs a costly workforce in hospitals and doctors’ offices that is dedicated to dealing with and defending against the challenges created by the health insurance companies. These costs are ultimately borne by patients.
Insurance companies are savvy and constantly alter their coverage rules and processes with an eye to maximizing their bottom lines. These companies also try to attract patients who won’t cost them too much and shed those who are expensive. This latter tendency can be expected to persist under a public option system and could doom the entire project (see above).
Because the public option would graft another insurance plan on to an already complicated and expensive coverage system, the public option will not heal and can worsen our healthcare landscape by delaying definitive solutions and by damping enthusiasm for genuine effective reform.
Is There a Plan That Has the Potential to Satisfy the Four Criteria?
The obvious solution is to remove the health insurance companies from the mix and join the rest of the industrialized Western world in enacting a single-payer system. Returning to the criteria used (above) to measure the public option, a single-payer system would
- Cover everyone;
- Lower costs;
- Reduce healthcare disparities, and
- Foster negotiations for healthcare necessities, such as pharmaceuticals.
In a nutshell, this is because a single-payer system refers to a common coverage system that covers everyone equally and whose administration is modelled on classic Medicare. This universal coverage would allow for real negotiating power.
If the Public Option Isn’t an Effective Reform, Why Do Politicians Promote This Plan?
The public option bobs to the surface again and again as a possible solution and a putative viable alternative to a single-payer program as it allows politicians to express concerns about healthcare in a way that does not threaten campaign contributions from insurance companies and Big Pharma.
In so doing, these various advocates have often portrayed single payer as “too radical” or “too impractical” to merit serious consideration
I can credibly be accused of being favorably disposed to single payer. The Mercatus Institute cannot. When this libertarian, Koch-funded, free-market-oriented organization set out to study the cost of a single-payer health system, their data did not discredit the economics of single payer but instead provided evidence that single-payer policies would lower healthcare costs.
In contrast to the views of politicians, ordinary Americans in increasing numbers are reporting that they are in favor of single-payer plans and are dissatisfied both with the cost of coverage and the barriers to care embodied in current health insurance coverage. Tellingly, when even Sarah Longwell of The Bulwark (an organization staffed by former Republicans) gives single payer consideration and predicts movement in the direction of single payer, one can argue that the current healthcare crisis may be creating an increased appetite for meaningful change.
Fool’s Gold
The public option cannot fix our healthcare woes. Moreover, adopting this “solution” has the potential to cause further damage to our healthcare mess. A public option is highly likely to prove fiscally unworkable. The failure of this shiny object to address the very real pain Americans are experiencing will delay consideration of solutions that can work. And, critically, a failure of the public option has the potential to extinguish a collective will to do the hard work of creating a healthcare system that works for all of us.
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The Simplicity of Medicare for All: Better, Cheaper, and Less Cruel
The current for-profit insurance system is designed to keep people from getting care. The failure of that is twofold. It's cruel on the one hand and on the other hand, it's inefficient and extremely expensive.
Oct 26, 2026
With soaring health care costs and a plunge in coverage rates, there is growing interest in Medicare for All. Polls show that a large majority of the public now favors a universal Medicare system, with even a substantial share of Republicans now backing it.
A universal Medicare system has a huge amount to recommend it. Of course, the main point is to ensure that people can get the health care that they need, but it also eliminates a vast amount of waste in the national health care system.
In addition to the $300 billion a year that we spend directly on operating the nation’s health insurance system, another $1.6 trillion is spent on administrative costs running our health care system by providers like hospitals and doctors’ offices, according to analysis by David Himmelstein, Terry Campbell, and Steffie Woolhandler. These additional costs are all the office personnel and various navigators involved in assisting patients in dealing with insurers. They found that in the United States we spend roughly 31 percent of each dollar in health care spending on administrative costs, whereas under Canada’s universal Medicare system, the cost is just 16 percent of spending.
The difference would come to around $900 billion a year, or $6,700 per household. Even that may be an understatement. Even if the United States spent the same share of health care costs on insurers as Canada, it would still be spending far more per person on these costs, because our expenditures on drugs, medical equipment, and doctors are close to twice as high. In short, there is a huge amount to be saved by having a universal Medicare system.
But the other part of this picture is also enormously important. Much, perhaps most, of the insurance system is designed to keep people from getting care. That’s not a conspiracy; it’s just how insurers work. They make money by not paying claims.
Sometimes this takes the form of nickel-and-diming people on claims, adding deductibles that may not be appropriate, or raising co-pays as high as possible. But it often means making it difficult for people to get access to expensive drugs or medical equipment or high-priced medical tests. Given the current structure of these industries, that may actually be desirable.
To be specific, suppose a doctor recommends a new cancer drug with a price tag of $100,000 a year, when it’s possible that an older generic drug, available at 1-2 percent of this price, could be just as good. Wouldn’t we want someone to be asking questions before making such a large commitment of public money?
The same story applies to tests like an MRI. Hospitals can charge several thousand dollars for an MRI. Wouldn’t it be reasonable to ask if an X-Ray for a couple hundred dollars is just as good?
But drugs, medical equipment, and medical tests don’t actually have to cost huge amounts of money. They are expensive because the government grants the pharmaceutical industry and the medical equipment industry patent monopolies.
Without these government-granted monopolies, both drugs and medical equipment would be cheap. It’s rare that a drug is expensive to manufacture and distribute. In a free market, the vast majority of drugs would sell for $20 or $30 a prescription, and many for less. We currently are spending around $750 billion a year on prescription drugs and other pharmaceutical products. That would likely fall to around $150 billion in a free market, for savings of close to $600 billion, or $4,500 per household.
The cost of medical tests and medical equipment would have a similar plunge. In that world, there would be little reason to keep a doctor from prescribing the drug they considered best for their patient, or the tests likely to produce the most accurate diagnosis. The difference in price between newly developed drugs and old generics would usually be negligible, as would the savings from using an X-Ray as opposed to the latest MRI.
This is just the Econ 101 principle that we maximize economic efficiency when items are available at their marginal cost. As the econ textbook tells us, the government-granted patent monopoly both raises prices and creates an enormous incentive for corruption (see “opioid crisis”).
It is necessary to pay for the research and development process that leads to new drugs and medical equipment, but this is not an impossible lift. We just pay for the research upfront. We already do this to the tune of more than $50 billion a year through the National Institutes of Health and other government agencies.
This sum would have to be tripled or quadrupled to make up for the loss of patent-supported research, but there is no reason to think that paying for research with direct public funding would be any less effective than with government-granted patent monopolies. In addition to eliminating much spending on pointless me-too drugs, there would also be the advantage that all research can be fully open. That means that instead of squirreling results away to be the first to secure a patent monopoly, researchers would be promptly sharing results (that would be a condition of funding) so that others could quickly benefit from successes and be warned away from dead ends.
I recently reviewed analyses of the work behind the development of four breakthrough drugs or treatments. In all four cases, all the key breakthroughs were the results of research funded by either the government or private charities. The pharmaceutical industry only came in to secure patent monopolies and do late-stage testing. The government can pick up the tab for the late-stage testing, which is not high science. And we don’t need the patent monopolies when the research is already paid for.
Replacing the system of patent-supported research with public funding will be a big undertaking and will face massive political opposition. The pharmaceutical industry would be prepared to spend billions to defeat a change to a system that has earned it trillions of dollars over the last decade. But this is a change that is a necessary part of moving to a healthcare system that provides quality healthcare to all at a reasonable price.
There will be other issues in moving to Medicare for All. We need to get out doctors’ pay (primarily specialists) more in line with the rest of the world. They currently get more than twice as much as doctors in other wealthy countries. And we will have to pace the transition; doing it overnight is likely to be a disaster. But it is long past time we start to go down this road.
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'Grifter Got Grifted': RFK Jr. Adviser Calley Means Quits as Trump 'Hemorrhaging' MAHA Support
One campaigner said that "activists should brace for even more deregulation of cancer-causing pesticides, forever chemicals in water, and flavored vapes aimed at kids."
Oct 22, 2026
In perhaps another signal that the "Make America Healthy Again" movement is feeling betrayed by US President Donald Trump, The Wall Street Journal revealed Thursday that Calley Means is exiting his role as an adviser to Health and Human Services Secretary Robert F. Kennedy Jr.
"I leave with tremendous respect for President Trump and RFK—two historic figures who are committed to confronting a corrupt DC bureaucracy that is doing everything possible to protect the status quo," Means said in a statement. "The past two years have seen historic policy and cultural change to confront the chronic disease crisis and healthcare incentives that profit from us being sick. This movement is in the first inning and just getting started."
White House spokesperson Allison Schuster told the Journal that "we are grateful for Calley Means' time in the Trump administration," and "he has done a fantastic job for the MAHA movement."
While the spokesperson applauded Means, the brother of the president's withdrawn surgeon general nominee, and the departing adviser praised Trump and Kennedy—whose partnership he has been credited with fostering—unnamed sources who spoke to various media outlets cited internal conflicts.
According to the Journal's sources, Means "was greatly frustrated by White House delays of some of Kennedy's most popular policy ideas and blamed others in the administration for allowing food companies and special interests to have too much sway," with one person describing him as "disillusioned."
CNN similarly reported:
Means, who had championed Trump as a candidate willing to overhaul the government's approach to food and health regulation, grew increasingly frustrated over delays in advancing a series of policies at the center of the MAHA agenda, three people familiar with the matter said.
Trump health officials had initially hoped that policies, including an effort to create a definition for ultraprocessed foods, would be finalized well before the midterm elections. Instead, they've faced continued delays in the White House and sharp pushback from major agriculture industry groups.
Means decided to quit primarily because of those delays, the people familiar with his thinking said.
Following those and other reports, Shaughnessy Naughton, president of 314 Action, which works to elect Democrats with a background in science to public office, said in a statement that "Calley Means has called it quits because the grifter got grifted."
"It's clear that top MAHA figures are distancing themselves from the administration because Trump and RFK Jr. have betrayed the promises that built their movement," Naughton continued. "Instead of taking on Big Food and Big Pharma, this administration has repeatedly sided with special interests, using Trump's signature Sharpie to boost the production of pesticides by executive order, loosen restrictions on peptides, and promote fruit-flavored vapes to children."
"The MAHA agenda is a failed experiment—RFK Jr. was the first to fold on the food industry, and we have a president who lives on a steady diet of cheeseburgers and Diet Coke—Trump was never going to be an ambassador for MAHA's food agenda," she added. "Nearly 50% of independents and swing voters say MAHA has failed to deliver on its promises, and Calley Means' departure confirms it. This administration has sold out the very people it claimed it would fight for. More heads will roll, and we expect RFK Jr. will be next in Trump's firing line."
Brad Woodhouse, president of Protect Our Care, declared that "Donald Trump is hemorrhaging MAHA support even from within his administration."
"Again and again, RFK Jr. helped Donald Trump sell out MAHA priorities to protect profits of the GOP's big chemical, food, and tobacco donors," he said. "Patience has already run dry for many MAHA supporters. Now Kennedy's right-hand man can't stomach staying in the administration after all the rug pulls, phony excuses, and corporate surrender."
"Means' exit is a clear sign that Donald Trump has no intention of mending MAHA fences," Woodhouse warned, "and activists should brace for even more deregulation of cancer-causing pesticides, forever chemicals in water, and flavored vapes aimed at kids."
The RFK Jr. adviser's departure followed the Monday publication of an analysis from the watchdog group Public Citizen titled "How Trump Conned MAHA," which lays out how far the administration has "strayed" from its own "warnings about hazardous chemicals in the environment and ignored its own advice about corporate influence and corrupted science."
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'Outrageous': Trump Loaded Up on Big Pharma Stocks While Jacking Up Drug Costs
"Trump and congressional Republicans intentionally force seniors to pay more for cancer treatment so that Big Pharma can rake in more money that Trump can personally profit from."
Oct 16, 2026
An analysis released Friday by Democrats on the congressional Joint Economic Committee details how US President Donald Trump loaded up on shares of major pharmaceutical companies last year as his administration and Republican allies enacted policies that benefited the industry—at the expense seniors and other patients.
The JEC analysis estimates that Trump increased his stock holdings in the pharmaceutical sector from $1.7 million in 2024 to as much as $56.2 million last year. The committee notes that Trump, who has repeatedly promised to cut drug prices while implementing policies that raised them, "held as much as $39.1 million in stock in the same Big Pharma companies that directly benefited" from a budget package that the president signed into law last summer.
“Trump and congressional Republicans intentionally force seniors to pay more for cancer treatment so that Big Pharma can rake in more money that Trump can personally profit from," said Sen. Maggie Hassan (D-NH), the JEC's ranking member. "It’s outrageous and yet typical from this president, who makes the American people foot the bill again and again for his own gains."
Tucked in the Trump-GOP budget law was a provision exempting some widely used, high-priced prescription drugs from Medicare price negotiations. Merck's cancer medication Keytruda was one of the drugs temporarily shielded by the provision; Merck appears more than 60 times in the president's 2025 financial disclosure.
The JEC analysis notes that "in 2025, Merck reported $18.8 billion in US revenues for Keytruda, which helped the company net $22.5 billion in profits that year, a 16% increase compared to 2024."
The president also made big purchases of stock in Johnson & Johnson, AbbVie, Pfizer, and Amgen last year. The JEC found that each of those companies "had at least one drug that benefited from the carveouts" in the Trump-GOP budget law.
Additionally, the Trump administration has entered friendly agreements with pharmaceutical companies in which the president is invested, including Pfizer and Eli Lilly.
“Trump’s drug pricing deals are a mirage, designed to convince Americans that he’s taken significant action on drug pricing while creating minimal if any downside for Big Pharma,” Peter Maybarduk, access to medicines director for the consumer advocacy group Public Citizen, said last month after his organization obtained heavily redacted texts of the agreements.
"The texts show Trump handing out favors to Big Pharma, undercutting his own models to lower prices, and throwing the support of the US government behind corporate decisions to deny medicines entirely to other countries," said Maybarduk.
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'A Match Made in Hell': Former GOP House Leader to Head Big Pharma Lobby
"Cantor, like PhRMA, is an experienced reverse Robin Hood, legislating money away from working families and toward giant corporations."
Sep 29, 2026
In what advocates for lower drug prices call "a match made in hell," one of the pharmaceutical industry's most powerful lobbying groups is tapping a former Republican leader in the US House of Representatives to head its political operations.
Pharmaceutical Research and Manufacturers of America (PhRMA) named former Rep. Eric Cantor (R-Va.) as its president and CEO on Tuesday amid what is shaping up to be a major fight over the government's ability to regulate prescription drug prices.
Cantor served in Congress from 2001-14 and was named House majority leader in 2011. He resigned in 2014 after losing his Republican primary in a stunning upset to the Tea Party-backed former Rep. Dave Brat.
According to recent polling from KFF, more than half of US adults say they worry about affording prescription drugs and nearly three-quarters say the government should do more to limit prices.
PhRMA emphasized that Cantor's appointment to replace the outgoing CEO Stephen Ubl comes at "a pivotal moment for America’s biopharmaceutical industry."
It is certainly spending like it. As Politico reported on Tuesday, pressure from voters to address the affordability of prescription drugs has been met with an unprecedented lobbying blitz by PhRMA, which poured a record $38 million into efforts to keep Capitol Hill in line.
PhRMA said Cantor’s “global business acumen coupled with policy and political experience at the highest levels of government make him an ideal person to lead PhRMA during this critical next chapter.”
Peter Maybarduk, the access to medicines director for the consumer watchdog group Public Citizen, agreed that Cantor was a perfect fit for PhRMA, but for very different reasons.
"Cantor, like PhRMA, is an experienced reverse Robin Hood, legislating money away from working families and toward giant corporations," Maybarduk said.
During his tenure in Congress, Cantor received roughly $900,000 from the pharmaceutical and health product industry, putting him 19th among all House candidates between 1999 and 2018, according to a JAMA Internal Medicine study of data from the Center for Responsive Politics.
That spending paid dividends, with Cantor voting against legislation aimed at lowering prescription drugs—including one bill in 2003 that would have allowed Americans to import low-cost prescription drugs from abroad and another in 2007 that would have required the federal government to negotiate drug prices for Medicare recipients.
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Secret Trump Drug Deals Reveal Perks for Big Pharma, Uncertainty for Patients
"The Trump team appears to be doing more to protect pharma profits than patients’ pocketbooks,” said Public Citizen.
Sep 20, 2026
The Trump administration’s secretive deals with Big Pharma to lower prescription drug prices included benefits for the companies that were not publicly disclosed, according to documents obtained by the consumer advocacy group Public Citizen via a Freedom of Information Act request and published Saturday.
Public Citizen said the deals allow drugmakers to raise prices overseas and limit the scope of promised savings for American patients.
“Trump’s drug pricing deals are a mirage, designed to convince Americans that he’s taken significant action on drug pricing while creating minimal, if any, downside for Big Pharma,” Peter Maybarduk, director of Public Citizen’s Access to Medicines program, said Saturday.
“The texts show Trump handing out favors to Big Pharma, undercutting his own models to lower prices, and throwing the support of the US government behind corporate decisions to deny medicines entirely to other countries,” he added.
Read Public Citizen’s analysis of Trump’s secretive deals with pharma: www.citizen.org/article/publ...
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— Access to Meds | Public Citizen (@pcmedsaccess.bsky.social) September 19, 2026 at 1:19 PM
The disclosures come as President Donald Trump continues to tout his “most-favored nation” (MFN) drug-pricing initiative. On Friday, the administration announced that all 50 states, Washington, DC, and Puerto Rico had applied to participate in a Medicaid program built around MFN pricing, under which participating drugmakers are supposed to offer certain medicines at prices comparable to those charged in other wealthy nations.
However, Public Citizen said the newly disclosed contracts raise questions about how much patients will actually save. The deal with Eli Lilly excludes the company’s blockbuster GLP-1 drugs Mounjaro and Zepbound from the definition of products subject to certain MFN discounts. Public Citizen said a similar carveout for Novo Nordisk could reduce potential Medicaid savings by $1.7 billion.
Eli Lilly’s agreement also permits the company to stop supplying a medicine to another country under certain circumstances, removing that nation’s price from the calculation used to determine the US MFN price.
“That practice threatens patients’ health,” Public Citizen said, adding that such provisions could effectively encourage pharmaceutical companies to make medicines unavailable abroad rather than reduce US prices.
“By agreeing to terms that endorse and facilitate pharma companies discontinuing supplying drugs in other countries, so they can continue to charge US customers more, the Trump team appears to be doing more to protect pharma profits than patients’ pocketbooks,” it said.
Public Citizen also said that the documents do not publicly reveal the full scope of tariff exemptions and other incentives provided to drugmakers, including reported benefits involving expedited US Food and Drug Administration reviews. The Pfizer agreement indicates that the company may share additional revenue generated by higher prices abroad with the US government. But crucial portions are redacted, leaving the public unable to determine how much money is involved, who receives it, or how it would be spent.
“The Trump administration continues to favor secrecy in these limited disclosures under FOIA today,” Maybarduk said, noting that the government has blacked out “the prices, product lists, and information needed to assess whether Trump accomplished anything of substance.”
Public Citizen's disclosures follow months of criticism over Trump's claims that his administration has dramatically reduced drug prices. In August, Sen. Elizabeth Warren (D-Mass.) accused the administration of failing to make the agreements public despite Health and Human Services Secretary Robert F. Kennedy Jr.’s previous commitment to provide them, saying, “still crickets.”
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Trump Pharma Deals Called Distraction From 'Failed Plan to Lower US Drug Prices'
"Lasting relief requires transparent, enforceable measures that lower drug prices and hold big drug companies accountable," said one critic.
Aug 31, 2026
US President Donald Trump on Monday announced nine more agreements with pharmaceutical manufacturers intended to lower prescription drug prices nationwide, bringing the total to 26, but patient advocates responded skeptically.
The administration previously struck "most favored nation" (MFN) deals with 17 large drug manufacturers. The new ones with midsized companies—Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals, and UCB—mean that 89% of the branded drug market is subject to an agreement, according to a White House fact sheet.
"It has been nearly a year since Trump announced his first secret MFN deal with Pfizer, and he has almost nothing to show for it," Peter Maybarduk, Access to Medicines director at the watchdog group Public Citizen, said in a Monday statement. "The new deals are a distraction from the administration's failed plan to lower US drug prices to the levels paid in other wealthy countries."
Earlier this month, Public Citizen released an analysis of Trump's policies to cut drug costs, including MFN deals. Maybarduk said at the time that "Trump has three kinds of drug pricing policy: fake, exaggerated, and not-real-yet, probably-won't-happen."
Following Monday's agreements, the campaigner argued that "a more serious approach would build international reference pricing into Medicare drug price negotiation. Instead, Trump is cozying up to Big Pharma and keeping American drug prices high."
"There still is no evidence that any pharma company has followed through on prior commitments to the Trump administration to launch new drugs at MFN price points," he explained. "Uptake of TrumpRx, which may cause consumers to overpay on medicines, has been lackluster."
TrumpRx is a government-operated website that helps patients find discounted prices and coupons for certain medications—and, as the Public Citizen analysis highlighted, the only part of the president's MFN program that is fully underway.
"The Centers for Medicare and Medicaid Services (CMS) has not announced any state participants in a pilot to test MFN-based prices in Medicaid," Maybarduk noted. "And CMS has failed to issue final rules to test MFN-pricing in Medicare, while simultaneously excluding almost all drug companies from these programs."
Public Citizen said it plans to immediately file a Freedom of Information Act request to obtain the texts of these "farce" deals—a pledge that came just days after US Sen. Elizabeth Warren (D-Mass.) highlighted that Health and Human Services Secretary Robert F. Kennedy Jr. has failed to publicize initial 17 agreements, despite agreeing to do so during an April hearing.
Like Public Citizen, the advocacy group Patients for Affordable Drugs was critical of the new deals, with CEO Merith Basey pointing out that "for decades, drug companies have been charging Americans at least four times more for brand-name medicines than people in other high-income nations."
"Patients need systemic reforms that will lower drug prices, rather than short-term, voluntary agreements whose terms remain secret," she asserted. "The deals announced today focus on Medicaid, where steep discounts already exist, and even then, states can choose whether to participate. Lasting relief requires transparent, enforceable measures that lower drug prices and hold big drug companies accountable."
As the industry trade publication Fierce Pharma reported, the large companies behind the initial deals "made a combination of drug pricing commitments and domestic investment pledges to win temporary immunity from the Trump administration's drug import tariffs," and "individual company press releases Monday, like UCB's, suggest that tariff immunity is still very much part of the MFN equation."
Although Trump's tried taking credit for a recent drop in medication costs, with the White House X account claiming Monday that he's "leveled the playing field, and made prescription drugs more affordable than ever for the American people," as Common Dreams reported earlier this month, experts have cited the Biden administration's policy allowing Medicare to directly negotiate some prices.
As Trump has touted his MFN deals, critics of the United States' for-profit healthcare system have in recent months renewed calls for shifting to Medicare for All—which new research shows would save over 114,000 lives and $1 trillion each year—and other healthcare reforms, including breaking up industry giants, capping drug prices, strengthening antitrust enforcement, and expanding the sector's workforce.
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'Still Crickets': Warren Reminds RFK Jr. of Pledge to Publish Secret Trump Deals With Big Pharma
"Why should Americans believe this isn't just another Trump handout to fatten Big Pharma's pockets?"
Aug 26, 2026
Nearly two weeks after US Sen. Elizabeth Warren wrote to the Trump administration's top health official in her latest attempt to get answers on "secret pricing deals" with Big Pharma, the Massachusetts Democrat said Wednesday that she is still waiting for the White House to make the terms of the agreements public.
On social media, Warren noted that she asked Health and Human Services Secretary Robert F. Kennedy Jr. to publicize the deals for medicines listed on President Donald Trump's direct-to-consumer website, TrumpRx, at a hearing in April.
"Will you make the deals available to us so we can see them, a little transparency?" the senator had asked.
Kennedy replied that he would be "happy to make the deals available except for proprietary information and trade secrets."
But as the agreements have appeared to do little to reduce drug costs, Kennedy responded to Warren's request in writing without providing "copies of the questionable agreements" or answers to her questions about "unproven claims that the website is saving patients money," the senator noted.
Instead, Kennedy's response raised "fresh questions about whether the Trump administration’s savings estimates are reliable."
Months after her initial request, Warren said Wednesday, "still crickets."
"Why should Americans believe this isn't just another Trump handout to fatten Big Pharma's pockets?" she asked.
As Common Dreams reported last week, experts have pointed to the Biden administration's policy allowing Medicare to directly negotiate the prices of some drugs as the major driver of falling prescription prices, which dropped 3.1% over the past year.
But Trump has claimed that the "most favored nation" deals his administration negotiated with 17 pharmaceutical companies were behind the falling prices, despite the fact that just one aspect of his MFN policy—TrumpRx—has been enacted, and the website has only been found to deliver savings on one out of 54 listed medications.
"While TrumpRx has since added a wider selection of generic drugs and added some information about generic alternatives to select pages, not every brand drug on TrumpRx with an existing generic alternative has that alternative readily available on the site, and a recent analysis finds that the TrumpRx deals represent only around 12% of brand drugs made by participating Big Pharma companies," wrote Warren to Kennedy on August 13. "Thus, consumers still risk overpaying for branded drugs despite the availability of cheaper generics."
She added that the administration recently made the "unfounded claim that TrumpRx has already saved more than $700 million for American patients," while saving the average user of prescription medications only about $5.
"Your response to me raises questions about whether even that estimate was made up out of thin air," wrote Warren, noting that Kennedy had admitted TrumpRx “does not store any patient, health, or prescription information."
She emphasized that drug manufacturers who signed the MFN deals with Trump "have benefited from huge tariff exemptions for branded drugs and received vouchers to fast-track approvals for new products. That is on top of billion-dollar handouts President Trump and Republicans in Congress gave to the pharmaceutical industry last year in their tax law."
"This is a huge win for giant drug companies that will reap billions in additional revenues from higher prices abroad, while doing absolutely nothing to lower drug prices for Americans in need," wrote the senator. "Americans are paying more on everything from school supplies to furniture thanks to Trump’s across-the-board tariffs, and instead of negotiating deals to help workers and American families, he’s using that leverage to go to bat for Big Pharma."
"Americans deserve to know whether the deals the administration is cutting with Big Pharma will lower their prescription drug costs—or just further enrich big drug companies," said Warren. "Despite my request that you make the administration’s MFN deals with giant drug companies public, and your commitment to do so, you have yet to follow through."
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Trump Claims on Drug Prices Range From 'Fake' to 'Exaggerated' to 'Probably Won't Happen': Analysis
"Trump’s claim to have lowered drug prices amounts to distortion and stealing credit from past administrations whose policies actually made a difference," said one expert.
Aug 21, 2026
A new analysis published Thursday argues that President Donald Trump's claims about prescription drug price reductions under his administration fall into one of three categories: "fake," "exaggerated," or "probably won't happen."
The analysis, released by the consumer advocacy group Public Citizen, came after Trump recently—and buffoonishly—tried to take credit for what was described as the largest year-over-year price drop in more than 60 years, even as experts said a Biden-era policy allowing Medicare to directly negotiate the prices of some drugs was likely the most significant driver of those cost reductions. Data from the US Bureau of Labor Statistics indicates that drug prices fell 3.1% last month compared to the previous year, apparently the biggest decline since 1963.
But Public Citizen emphasized that the Trump administration "did not publish the methods they used for their analyses so that their work can be independently verified."
"For example, because the [Consumer Price Index for Prescription Drugs] is indexed to 1982, the administration would have had to recalculate the index in earlier years to make proper comparisons dating back to the 1960s, and we don’t have information on how this was accomplished," the group's analysis notes. "We also don’t know where they started the time cut offs for presidential administrations in their graph comparing Trump’s supposed achievements to other presidents. Team Trump has a history of misleading Americans using CPI-Rx data by for example picking arbitrary baselines that make their achievements look better. Their lofty claims were disproven in the past."
Public Citizen also took issue with the Trump White House's assertion that the president's "most favored nation" (MFN) deals with pharmaceutical companies are responsible for falling drug prices. The group observed that the only element of Trump's MFN agenda that has been fully launched is TrumpRx, which has not exactly delivered blockbuster savings.
"That’s in part because most Americans have health insurance and will do better purchasing drugs through their insurance plans," Public Citizen said. "TrumpRx may also cause consumers to overpay on brand drugs, as many of the medicines on the site have cheaper generic competitors available at lower price points."
The more likely cause of falling drug prices overall, according to Public Citizen, were "the genericization of expensive branded drugs," the Biden-era Medicare price negotiation program that Trump and congressional Republicans have worked to sabotage, and regulatory changes that took effect in 2024, prior to the start of Trump's second White House term.
“Trump has three kinds of drug pricing policy: fake, exaggerated, and not-real-yet, probably-won’t-happen,” Peter Maybarduk, access to medicines director for Public Citizen, said in a statement. “Prescription drug corporations are raising the prices of new medicines every year, and the CPI doesn’t even count that cost. It’s more likely that patent cliffs and Medicare price negotiation, which took effect this year and saved billions, drove changes in the CPI."
"Trump’s claim to have lowered drug prices amounts to distortion and stealing credit from past administrations whose policies actually made a difference," Maybarduk added.
Last weekend, Trump showcased to reporters a printout of a Washington Post story headlined, "Prescription drug prices record sharpest drop in more than 60 years."
"I told you that was going to happen," the president said.
Trump didn't mention that the Post's story highlights experts' view that "a Biden-era policy that requires Medicare to negotiate prices for some popular prescription drugs is more likely to be driving down costs."
Richard Frank, a senior fellow at the Brookings Institution and professor emeritus of health economics at Harvard University, told the newspaper that "if I was a betting guy on what mattered most, it would be probably stuff around the Inflation Reduction Act," Democratic legislation that included the Medicare drug price negotiation changes.
Trump’s policies, Frank added, "wouldn’t be where I’d place my money."
The president's attempt to take credit for falling drug prices came as his administration actively worked to undermine the price negotiation program that's helping drive costs down.
A Public Citizen investigation published earlier this month revealed that "a quiet change in policy interpretation" that the Trump administration wants to make permanent allowed AbbVie’s pancreatic enzyme medication Creon to escape Medicare price negotiations for at least another seven years.
“The Trump administration wants to make permanent a costly Medicare mistake, which creates windfalls for AbbVie and other drug corporations by excluding some expensive biologic drugs from negotiations for years,” said Maybarduk. “Medicare price negotiation already is far too generous to drugmakers, which gouge Americans for many years before negotiated prices kick in.”
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Pharma Giants Reap Record $300 Billion in Revenue Under Trump as Millions of Americans Ration Medications
"Yet again, Trump has betrayed the American people and put billionaires ahead of working families.”
Aug 14, 2026
The world's ten largest pharmaceutical giants reaped around $300 billion in combined global revenue during the first half of 2026 as millions of people in the US—the country with the highest drug prices in the world—stretched, skipped, or rationed doses to afford their medications, despite President Donald Trump's lofty pledges to slash costs.
An analysis released Thursday by the advocacy group Protect Our Care estimates that Johnson & Johnson, Novartis, AbbVie, Merck, Pfizer, and other pharma behemoths collectively reported $298 billion in revenue in the first half of the year—a $24 billion increase compared to 2025—and distributed $63 billion in benefits to shareholders in the form of share repurchases and dividends.
"The numbers speak for themselves," said Vaishu Jawahar, director of policy programs at Protect Our Care. "While big drug companies make record-breaking sales, raking in billions more than they did last year, a growing number of Americans are struggling to afford their prescription drugs. Yet again, Trump has betrayed the American people and put billionaires ahead of working families.”
Throughout his second White House term, Trump has made mathematically impossible claims about his efforts to curb drug costs, asserting repeatedly that he has cut prices by upwards of 1,000%. Critics of the Trump administration's approach have noted that it has relied on voluntary and secretive deals with pharmaceutical companies, which have gone on to raise prices after meeting with the president and showering him with praise.
One high-profile administration initiative, TrumpRX, has been widely denounced as a scam that will do virtually nothing to lower drug costs for most Americans. The president has also worked to weaken the Medicare drug price negotiation program established during the Biden administration.
“Instead of lowering drug prices for seniors, Trump is holding backroom deals with big drug companies and handing them blockbuster giveaways," said Jawahar. "He has created loopholes for industry giants to evade price negotiations and jack up drug prices for seniors."
The advocacy group Patients for Affordable Drugs noted in a March report that during the first week of 2026, pharmaceutical companies "increased prices on 64 oncology drugs, with 73% of hikes exceeding inflation."
Sixty percent of US adults say they are struggling or worried about being able to afford their prescription medications, according to recent polling from the health policy research organization KFF. The group said that number marked the highest level since 2018.
Separate polling released in March by the West Health-Gallup Center on Healthcare in America found that tens of millions of people in the US "said they have made at least one trade-off with daily living expenses to afford healthcare," including skipping a meal, prolonging a current prescription, and cutting back on utilities.
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