Tangle Podcast Episode Summary
Title: Will Trump's Executive Order Reduce Drug Prices?
Host: Isaac Saul
Release Date: May 14, 2025

1. Introduction and Exciting Announcements

Timestamp: [02:20] – [06:09]

In this heartfelt segment, host Isaac Saul celebrates his birthday, marking six years since the inception of the Tangle Podcast. He encourages listeners to support the podcast by spreading the word or becoming members. More importantly, Isaac announces the hiring of Camille Foster as the new Editor at Large. Camille, praised for his inquisitive and open-minded political insights, will contribute to the weekly podcast, written pieces, and help shape Tangle's daily coverage. Isaac expresses pride in the growth of Tangle, now boasting 15 full and part-time employees, a significant expansion from its humble beginnings.

Notable Quote:

"He's one of the most inquisitive, open-minded, and perhaps most importantly, unpredictable political thinkers in America today. I love his brain."
— Isaac Saul [02:50]

2. Main Story: Trump's Executive Order on Drug Prices

Timestamp: [06:09] – [22:21]

2.1 Overview of the Executive Order

President Donald Trump introduced an executive order aimed at lowering prescription drug prices in the United States through a "Most Favored Nation" (MFN) pricing strategy. The order mandates the Secretary of Health and Human Services (HHS) to set price targets by tying U.S. drug prices to those in other OECD countries. Trump asserted that this policy would lead to immediate reductions in drug costs by 50% to 90%.

Notable Quote:

"Prescription drug prices will drop almost immediately."
— President Donald Trump [07:56]

2.2 Reactions from the Political Right

The right-wing responses are mixed but largely revolve around the feasibility and implications of the order.

• Scott McKay, American Spectator:
  McKay supports the order, arguing that it addresses the lack of a free market in U.S. prescription drugs, labeling the current system a "cartel market" where American consumers are unfairly burdened.

  Quote:

  "We are being grossly overcharged compared to the rest of the world."
  — Scott McKay [12:00]

• Michael F. Cannon, Cato Institute:
  Cannon criticizes the executive order, stating that HHS lacks the authority to impose such price controls without congressional support. He suggests alternative measures like expanding regulations to allow drug reimportation.

  Quote:

  "Price controls are never the answer."
  — Michael F. Cannon [15:30]

• Dace Potus, USA Today:
  Potus views Trump's approach favorably, noting it aligns more with free-market solutions than socialist price controls. He advocates for increased competition and lifted import restrictions to naturally lower prices.

  Quote:

  "Trump is claiming he is a man who cannot be bought...perfect vessel to usher in policies that drug companies hate."
  — Dace Potus [17:15]

2.3 Reactions from the Political Left

Left-leaning perspectives are cautiously skeptical about the efficacy and execution of the order.

• Emma Freer, MSNBC:
  Freer acknowledges the high drug prices in the U.S. but criticizes the vague nature of Trump's order, pointing out its lack of concrete measures and oversight on key players like Pharmacy Benefit Managers (PBMs).

  Quote:

  "Trump's order is so vaguely worded that it's not clear if the rules would only apply to federal programs."
  — Emma Freer [19:45]

• Bloomberg Editorial Board:
  The board highlights the complexities of drug price negotiations, emphasizing that while MFN pricing could lower U.S. costs, it might also inadvertently stifle innovation and lead to shortages.

  Quote:

  "Such a strategy could backfire for particular drugs."
  — Bloomberg Editorial Board [20:20]

• Jonathan Larson, TFN Newsletter:
  Larson argues that Trump's framework unfairly ties U.S. drug prices to European rates without addressing systemic issues like executive compensation and the true drivers of pricing.

  Quote:

  "Trump is pegging the cost of drugs here to the cost of drugs in Europe. Never mind the disparity in pharmaceutical executive compensation."
  — Jonathan Larson [21:30]

3. Camille Foster’s Policy Analysis

Timestamp: [22:21] – [28:08]

Camille Foster delves into the political and practical ramifications of Trump's executive order. He observes the unusual political dynamics, noting that drug price reforms are traditionally left-wing policies, making Trump's adoption of MFN pricing a significant ideological shift.

Foster acknowledges the validity of the problem—U.S. consumers pay significantly more for prescription drugs than their international counterparts. However, he expresses uncertainty about the order's practical outcomes, citing potential enforcement challenges and the opaque mechanisms of implementation.

He highlights key concerns:

• Enforcement Ambiguity:
  It remains unclear how significantly pharmaceutical companies must reduce prices to meet MFN targets or what specific enforcement actions will ensue.

• Impact on Innovation:
  There's apprehension that price controls could dampen pharmaceutical innovation and lead to drug shortages, despite the current lack of a true free market in drug pricing.

Notable Quote:

"We already don't have a free market in drug pricing, so sensible government action is necessary, but the risks are significant."
— Camille Foster [24:15]

Foster concludes that while Trump's intentions may address a real issue, the execution carries substantial risks, and historical precedents suggest that similar policies could lead to unintended negative consequences.

4. Questions Answered: Tariffs and Treasury

Timestamp: [28:08] – [31:26]

Laura from Michigan poses a question regarding the destination and utilization of tariff revenues collected by the government. Isaac clarifies that these funds are deposited into the Treasury's General Affairs Budget, which finances various governmental operations like employee salaries and infrastructure. Despite increased tariff revenues—reaching an all-time high of $16.3 billion in April—the federal government continues to operate with a significant deficit exceeding $1 trillion. Therefore, the additional revenue from tariffs alone is insufficient to balance the budget.

Notable Quote:

"The federal government is still running a spending deficit of over $1 trillion this fiscal year."
— Isaac Saul [30:45]

5. Under the Radar: Columbia River Treaty

Timestamp: [31:26] – [35:09]

Isaac highlights a lesser-known issue amid U.S.-Canada trade negotiations—the future of the 60-year-old Columbia River Treaty. This agreement governs water allocations from the Columbia River, a critical source of hydropower for both nations. Recent negotiations stalled after President Trump suggested that Canada could become the 51st U.S. state. Without a new agreement, hydropower production's reliability could be jeopardized, posing risks to energy infrastructure and regional economies.

Notable Quote:

"If a new agreement is not reached, U.S. hydropower production could become less predictable."
— Isaac Saul [32:10]

6. Numbers Section: Prescription Drug Statistics

Timestamp: [35:09] – [35:47]

A concise overview of key statistics related to prescription drug spending in 2022 and 2023:

• Global Spending:
  Total worldwide prescription drug spending reached $989 billion in 2022.

• U.S. Share:
  The United States accounted for 62% of this global expenditure.

• Drug Types:

  • Unbranded generics made up 90% of drug volume but only 8% of U.S. spending.
  • Brand-name originators comprised 7% of volume but 87% of spending.

• Price Multipliers:
  U.S. retail prices for selected brand-name drugs were two to four times higher than those in Australia, Canada, and France.

• Public Opinion:

  • 61% of U.S. adults take at least one prescription medication.
  • 73% believe there should be more government regulation to limit drug prices, with bipartisan support across Democrats (82%), Independents (67%), and Republicans (68%).

7. Have a Nice Day: Andres Munoz and Pet Rescue

Timestamp: [35:47] – [36:20]

Rising Seattle Mariners pitcher Andres Munoz partners with Seattle Area Feline Rescue to auction an experience package, including game tickets and a meet-and-greet. Inspired by his 14-year-old Persian rescue cat, Matilda, Munoz emphasizes the joy pets bring and the importance of supporting animal rescue efforts.

Notable Quote:

"Pets give you a lot of happiness. That is why it's really important for me."
— Andres Munoz [35:58]

Conclusion

In this episode of Tangle, Isaac Saul navigates the complex terrain of President Trump's executive order aimed at reducing prescription drug prices. Through diverse perspectives from both the political right and left, along with Camille Foster's insightful analysis, listeners gain a comprehensive understanding of the potential impacts and controversies surrounding the policy. Additionally, the podcast addresses listener questions, sheds light on lesser-known international treaties, and presents pertinent statistics that underscore the ongoing challenges in U.S. pharmaceutical pricing.

Listeners are encouraged to support Tangle by becoming members or sharing the podcast, ensuring continued independent and non-partisan political discourse.

Note: For more detailed information and to explore membership options, visit readtangle.com.