Bulwark Takes: Trump Pulls Classic “Donnie Bait-and-Switch” on Drug Prices
Release Date: May 12, 2025

Introduction

In this episode of Bulwark Takes, Sam Stein, the managing editor at The Bulwark, engages in a comprehensive discussion with Jonathan Cohn, author of the Breakdown newsletter, about President Donald Trump's recent executive order aimed at addressing prescription drug prices. Titled "Trump Pulls Classic 'Donnie Bait-and-Switch’ on Drug Prices," the episode delves into the specifics of the order, its potential impact, and the broader political implications surrounding it.

Overview of Trump's Executive Order

Sam Stein opens the conversation by referencing Trump's teaser about his new policy on prescription drugs. Jonathan Cohn provides an in-depth explanation:

[00:28] Jonathan Cohn: "The basic concept here is that we pay much more for our name brand prescription drugs than every other economically developed country. Trump's answer is to negotiate with drug companies to match the prices set by other countries, asserting that the U.S. is being 'ripped off.' He refers to this approach as 'Most Favored Nation Status.'"

Cohn emphasizes that the executive order does not immediately implement drastic price reductions but outlines a framework for negotiating lower prices based on international benchmarks.

Details of the Executive Order

Sam Stein points out the initial promises versus the actual content of the order:

[02:04] Jonathan Cohn: "Trump promised an immediate reduction in drug prices by 30% to 80%, which the executive order does not deliver. Instead, it mandates that the administration determine what other countries pay and negotiate with drug manufacturers to align U.S. prices accordingly within a set timeframe, potentially around two months."

Key points discussed include:

• Scope of Drugs Affected:
  The order does not specify which drugs will be targeted, leaving it open to interpretation and future rule-making.

  [03:49] Jonathan Cohn: "It does not specify which drugs or outline the exact mechanisms for enforcement."

• Legal Authority and Limitations:
  The discussion touches on the constitutional and legislative boundaries of the executive order, particularly concerning Medicare and Medicaid.

  [04:15] Jonathan Cohn: "While the executive branch has substantial authority through Medicare to experiment with payment models, extending this to Medicaid or private insurance would likely require congressional action, which is currently unlikely."

Political Dynamics and Inverted Politics

A significant portion of the discussion focuses on the political irony and inversion occurring with Trump's approach to drug prices, traditionally a progressive issue.

Sam Stein introduces a clip from RFK Jr., highlighting the unexpected alliance:

[06:38] RFK Jr.: "This is the fulcrum of Bernie Sanders' agenda. Trump is ushering it in."

The conversation reveals:

• Unexpected Endorsements:
  Despite being a Republican, Trump’s actions align closely with long-standing Democratic promises to reduce drug prices, creating a unique political twist.

  [07:15] Jonathan Cohn: "This concept is philosophically aligned with Bernie Sanders and the broader Democratic Party's stance on drug pricing."

• Historical Context and Biden's Role:
  Cohn contrasts Trump's executive order with President Joe Biden's efforts, noting Biden's legislative achievements in allowing Medicare to negotiate drug prices, albeit in a more limited capacity.

  [08:00] Jonathan Cohn: "Biden prioritized leveraging Medicare to negotiate prices, an underappreciated accomplishment that was slowly implemented due to strong pharmaceutical lobbying."

Potential Outcomes and Industry Response

The discussion moves toward the feasibility and potential effectiveness of Trump's executive order.

[09:53] Jonathan Cohn: "There’s a possibility that some drug companies might voluntarily reduce prices to appear cooperative, allowing Trump to declare a victory even if substantive changes are minimal."

Cohn expresses skepticism about the administration's commitment and capability to enforce significant changes:

[10:05] Jonathan Cohn: "I don’t see the Trump administration effectively following through on this. Historically, they lack persistence in such initiatives, often settling for superficial wins."

Conclusion and Future Implications

Sam Stein wraps up the conversation by reflecting on the broader implications of this policy shift:

[10:34] Sam Stein: "This move by Trump not only impacts drug pricing but also sets the stage for future administrations to build upon, illustrating the 'horseshoe theory' of political convergence."

Jonathan Cohn concurs, highlighting the cyclical nature of political strategies:

[10:57] Jonathan Cohn: "Trump’s actions could pave the way for a more committed effort by subsequent presidents, regardless of party affiliation, to tackle high drug prices."

Key Takeaways

1. Executive Order's Intent vs. Reality:
   While Trump’s executive order aims to reduce prescription drug prices by enforcing international price parity, the actual measures are less aggressive than initially promised.

2. Political Irony and Alignment:
   A Republican president advancing a policy long championed by Democrats showcases a significant political inversion, blurring traditional partisan lines on drug pricing reforms.

3. Legal and Practical Challenges:
   The lack of specificity in the order and potential legal hurdles may limit its immediate effectiveness, with substantial resistance likely from the pharmaceutical industry.

4. Potential for Future Policy Development:
   Trump's actions may lay the groundwork for more comprehensive reforms by future administrations, regardless of political affiliation, highlighting the enduring challenge of high drug prices in the U.S.

Notable Quotes with Timestamps

• [00:28] Jonathan Cohn: "We pay much more for our name brand prescription drugs than every other economically developed country."

• [02:26] Jonathan Cohn: "If the drug companies do not within the set timeframe bring down their drug prices, he is going to enforce reductions through mechanisms like importing drugs from abroad or imposing penalties."

• [06:38] RFK Jr.: "This is the fulcrum of Bernie Sanders' agenda. Trump is ushering it in."

• [07:15] Jonathan Cohn: "This concept is philosophically aligned with Bernie Sanders and the broader Democratic Party's stance on drug pricing."

• [09:53] Jonathan Cohn: "Drug companies might voluntarily reduce prices to look cooperative, allowing Trump to declare a victory even if substantive changes are minimal."

Closing Remarks

Sam Stein and Jonathan Cohn provide a nuanced analysis of Trump’s executive order on drug pricing, exploring its potential impact, the political dynamics it encapsulates, and the broader implications for future healthcare policy in the United States. The episode underscores the complexity of drug pricing reform and the intricate dance between political promises and legislative execution.