Seth Mandel (6:21)

Well, not unfair, but I think the concern is that the hostage negotiators with the Trump administration are getting in the habit Of I don't want to say manipulating, but I kind of do want to say manipulating the hostage families themselves, working them against the, against Prime Minister Benjamin Netanyahu because they told them, you know, as you said, they told them, we're going to get everybody out and all that. But before that, Steve Witkoff told the families reportedly that that BB is prolonging the war for no reason. And telling the hostage families this was a very calculated move because he, and apparently according to reports, he, he made sure that someone in his office leaked those comments. Was probably Steve Witkoff speaking and then Steve Witkoff leaking John Baron and as John Barron.

Tevy Troy (7:28)

Right.

Seth Mandel (7:29)

So all the Witkoffs are very, so he's stage managing the way that he's talking to the hostage families. And the hostage families have outsized influence in the way that the public perceives the conflict. Right. Because the protests, there will be protests out in the street to stop the war. There have been increasingly. And the hostage families being told that it is, they are, it is mutually, is a mutually exclusive choice to win the war or to bring the hostages home is, I think, a manipulation. And I think it's the sort of thing that bleeds into the rest of the public discourse of this because certain things are rarely said until a hostage family says them, if you know what I mean. There's just certain things the hostage families are given a certain sense of priority in setting the tone of the discourse around the hostages themselves for, I think, understandable reasons. And so feeding the hostages these types of talking points is a way to influence the fuller discourse. But if it's not correct, it's not a noble thing to do. You know, it's, it's he want, if he wants victories, if he wants to be able to, to, to ratchet to ratch up, notch up victories through hostage deals and stuff like that, things he can brag about, then you know, that's not a noble cause. Bringing this, bringing the captives home is a noble cause. And the way he's going about it suggests that there really is a rift between the United States government and the Israeli government at the moment over how to proceed. And that if that's true, that means the Trump administration is leaning toward looking at excuses to stop the war, essentially.

Christine Rosen (9:28)

Well, and that's where the tone and talk of deal making is really startling when what we should still be hearing. I mean, you can talk about the deal making, but every time there should be the moral obligation to destroy Hamas, end Hamas, eliminate Hamas. That I don't hear coming from anyone, even from the leakers or from Trump himself. I mean, occasionally he will say, you know, Israel, Israel has to destroy Hamas. But it should always be attached to the discussion of the hostages, because they wouldn't be there were it not for this situation. And that in that sense, I've seen a lot less of that rhetoric from anyone in the Trump administration in recent weeks and much more. And I agree with you, John. The tone of congratulations is for himself. It's not actually for the family or for. Or for Adan. So it's just off, it seems a little off. And this combined with what we know about some distancing between Trump and Bibi is concerning because the war continues. In fact, it might be about to ramp up considerably. And I think this administration needs to reassert where it stands on the conflict.

Abe Greenwald (10:31)

And I share the concern with everyone here because it's also the kind of thing where I think ending wars is always an easy sell. Whether they really end or they don't, whether the war is righteous. It's like, and this has been a long war, so it's like Ukraine, when you say, you know what, it's too much. People just needs to stop. We just need to end this war. People jump right on board and it becomes a kind of fever. And it's a default position today.

John Podhoretz (11:10)

Right. So a couple of complications here. Domestically, inside Israel, Bibi Netanyahu has, is fighting wars on two fronts. One of the fronts, polling says that the Israelis want the hostages home over, over feeling that the war was successfully concluded, that they, that they privilege that over one over the other. Some of that is a kind of reverse PC, that is to say that it's something that you feel like you need to say if you're an Israeli. Otherwise you sound heartless and mean and like you don't understand that these children could be these people who are taken hostage, could be your family members. But he's fighting that and he's fighting an entire leftist security establishment. 563 Israeli officials issued a statement yesterday essentially saying the same thing the rabbinical assembly said, which is end this war now. There's no, there's no purpose to it. We need to get the hostages home. These are all efforts, that is an effort to topple Bibi's government. Just to make this clear. That is, they may believe it, they may not believe it. Bibi's own government inside his own coalition. The more nationalistic parties, the more right wing parties, as we say, want the war to be fought to a successful conclusion and believe that it is. That is the main goal. And BB has had to reassure them in the last 12 hours that he is with them, that that is his purpose, that is his intention and all of that. But he does have Trump in the region. He has Trump making nice with the gutteries. The gutteries are the representatives of Hamas. They are the negotiating representatives of Hamas. They're giving him a plane, they're treating him like he's God. And who knows what words will be spoken in his ear during this trip to say, as we know he's willing to say in relation to Ukraine, very different situation. But like, just end this now. Let's get over this. And, and so Netanyahu has sort of lost control of this narrative. People are saying, well, why are we even fighting this war? I mean, they're very simple answers that somehow are now lost in the haze here. One is you need to win this war, conclude it, and end with Hamas ruined and destroyed so that no future Israelis are taken hostage by enemies of Israel on their borders or elsewhere or in, you know, when they're traveling on their gap years or in their year that they take a trip after they leave the army, if they're traveling around Thailand or something like that. Like, Israel needs to make it clear that it will no longer countenance the use of its people as cats paws in this way. Otherwise there's going to be more of it. And that is the story of the last 14 years since the negotiation that end up ended up with the release of Gilad Shalit, the hostage taken in 2006 and released in 2011. This became an active tool of war for the enemies of Israel. And it turns out if it turns out to be a successful way, the final gambit to secure an aim, even if Israel will have gotten 90% of the way there, then that's just, it's open season as long as there are people who can do it. And there's the west bank, there's, there's still Hezbollah forces in Lebanon. Even if Hamas gets destroyed, I mean, it's not great. And Israelis seem to have lost the plot that it's been an incredibly long war. And you can't blame them for losing the plot. It's a nightmare. And it's, you know, 18 months and Israel has never fought a war this long. What's more, we barely ever fought a war this long since Vietnam. We haven't fought a war this long at all. The active combat time in Iran, in Iraq and in Afghanistan was halting and not as fixed as this is with as many percentage of the population involved in war, as is the case here. And they're exhausted and they're, you know, and they're heartbroken and they want the hostages home. And he, Netanyahu, does not have the confidence of the people. People say the most horrible things about him. Like he wants the hostages to remain in captivity because it helps him politically. That's just a monstrous, monstrous thing to say. Like, I wouldn't say that about my, you know, I really honestly would not say that about my worst enemy. And yet, you know, people in Israel just say it routinely now, and there's some hint that Witkoff kind of said it in that meeting. And so, you know, it's a very, very bad, emotionally fraught situation. And Israel is also frozen in place until Trump leaves the region, having called up all these reservists to do a final push to win in Gaza. And they've called up all these people, and they're not going to do anything until Trump leaves. And who knows what's going to happen while Trump is still there.

Christine Rosen (16:55)

Well, in the, the, the fact that Trump is not visiting Israel is something, it really is worth noting. He should and he's not. And this is a big business deal making trip for him. Crypto. I, you know, you can list all the, all the deals he's, he's making, and that's very much the emphasis. We're going to, we're going to make all this money for America and actually, of course, line his own family's pockets in the process. But it does, you know, he has leverage or could have leverage with Saudi Arabia, for example. Where's, where are the Abraham Accords now? Why isn't that phrase even come up much in any of the discussion of this trip to the Middle East? There are so many points along which he is either on purpose or inadvertently distancing himself from the conversation about Israel. And I don't think it's, I think there are people in his administration who want to see that gap widen. And I think it's, it's really incumbent on supporters of Israel in the Republican Party to make sure that that doesn't happen. I've just been very, it's been very disconcerting reading coverage of this trip that Trump is taking, not just for the questions of ethics and his wheeling and dealing, but for how he's talking about why he's in the region. There is an ongoing war in the, in the region he's visiting. Why isn't he talking about it?

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Seth Mandel (21:22)

Abraham Accords are coming up just in the context of adding Iran. That doesn't give you comfort. But that's not what you're looking for, Christine.

Christine Rosen (21:32)

No, not the direction I was hoping.

Abe Greenwald (21:35)

It would head, you know, but there's a thing about this administration and foreign policy which is that Trump clearly is prone to taking the easy way in the sense that he doesn't want to have to put real pressure on enemies.

John Podhoretz (21:57)

And.

Abe Greenwald (22:01)

Seemingly intractable, seemingly people bent on our allies destruction and whatnot. The easy way is to pressure your friends. Right? So, you know, in that sense, Ukraine and Israel are similar vis a vis Trump, which is, which is that, you know, he's going to talk to Putin and pressure Zelensky, he's going to talk with Hamas, he's going to talk to Qatar and pressure Bibi and we're just going to end things soon because that's the sort of shortsighted, easy done with the mess. Get our friends to help us get a win in quotes.

Seth Mandel (22:50)

And if you've been listening, as many of you have to the commentary podcast all along, you've heard us warn, right, that this was a distinct possibility, right? When we talk about Ukraine, we've had discussions on this podcast about how the attitude toward Ukraine, which is, you know, pressure the ally or whatever. But also we just want this to end. We don't have the patience for it. That sort of thing could easily seep into his Israel related policy because he does have people all around him, as you say, that you know, that that are skeptical of the alliance or more skeptical than they used to be. And we saw and there was a story in the New York Times and about the why Trump called a truce with the Houthis. And the story alleges that he gave, he basically gave the army a 30 days to do something convincing to the Houthis. And on the 31st day he was like, all right, well, you know, time's up or something like that. You know, it's if he, if he's going to have be able, if he's going to show the kind of impatience that to be fair, American presidents almost without exception show when it comes to foreign engagement, if he's going to be just another one like that, then there's no reason to assume that his patience would be permanent only with Israel.

John Podhoretz (24:17)

Well, look, so it's funny you mentioned sort of 30 days for the Houthis. Because we have this example in the past in 2006, under the George W. Bush administration, which was, until Trump's, the friendliest administration to Israel that America has ever had. And when Israel found it necessary to go into Lebanon after cross border incursions and hostage taking and various other actions by Hezbollah, America supported Israel's efforts. And then on day 32, Condoleezza Rice, the Secretary of State, said, okay, that's enough, get out of there. Can't, can't, can't take it anymore. You're done. We're through being supportive of you. Now, Trump hasn't done that, obviously. And Trump has not said, you should stop fighting. We don't know what's being said. Behind closed doors. We are told that things have gotten rocky between Trump and Netanyahu. I don't. That may not be true. Like, it actually, it's not like there's any open evidence that that's the case. It's more like people in the administration who don't like Netanyahu because they are the restrainers and the anti Israel types may be leaking this out, Wyckoff may be leaking it out in order to put pressure on Bibi to bend to him. But even if all of that were the case, there is a healthy history of American support being withdrawn at some point or other. And the notion that, like, look, you did them in, they're mostly gone, they're mostly dead. They're most, they're not gonna, they're not gonna take over, God, you know, whatever. So just, you know, let us negotiate for the rest of the hostages and we'll say, okay, we're just, everything's, we're going to have a five year ceasefire, okay? And then you can, we'll get 20 people out and then everything will be fine. So, Tevi, you have any thoughts on this matter?

Tevy Troy (26:24)

Well, absolutely. As you know, John, I've written for you about all the presidents that Bibi has dealt with. And it's always complicated. He's had complicated relationships with Republicans and Democrats. If you recall, on the George H.W. bush administration, he was banned from the White House when he was a young aide at the embassy. So Bibi has a way of irritating American presidents because of his philosophy that he got from his dad, which he got via Jabotinsky, which is you're not directly negotiating with the President, with the leader, but with the American people. You're making your case to the American people. And all presidents don't like it when you go over their heads that said, there's also an effective aspect to the strategy. And so there's a reason he does it. I just want to add one more thing to what Seth was saying about the trip to Israel and not visiting or the trip to the region not visiting Israel. Remember, Barack Obama did this at the beginning of his administration. His first trip abroad was to the Middle east, didn't go to Israel. And we, you guys at the commentary and myself, we rightly gave him a lot of guff for doing that because we thought it was a really bad signal. And I think it's a bad signal here as well.

John Podhoretz (27:28)

Fair enough. So Trump's there for another three or four days. The question is whether Wyckoff and has a lot on his plate. So they got Idan Alexander out. That's the American. He could like, call it a win and move on. Or whether he is going to try to use the remaining hostages as a lever to get Bibi to agree to some kind of semi permanent ceasefire and freeze efforts in place before the final push the final offensive into Gaza, which is a very complex operation because it really does involve the reoccupation of parts of Gaza and the potentially semi permanent occupation of areas in Gaza in order to prevent Hamas from sprouting up again in order to make sure that there is the, that they can complete the destruction of the tunnel system and things which, which turns out to be even more extensive than, than people thought. And they are still finding tunnels they did not know existed. And of course, going into the tunnels is an incredibly laborious, dangerous, highly dangerous thing because you don't know what's booby trapped, you don't know what could cave in on you and all of that. And so there is a huge Israeli temptation even to give into this. It's just that Bibi's coalition probably can't survive his agreeing to the ceasefire because it's not as though if the far right wing parties leave his coalition, that's about 14 seats. It's not as though they will be replaced by people in the center who will be so grateful that he agreed to do this, to get the hostages out that they will come in and join the government. Right? They're not going to do that. So the government can in fact collapse and they can go to new elections, that he may win the new elections. But nonetheless, this is a very, very complicated situation that we're sitting on here and that America is involving itself in a way that it need. Once again, it's so weird that Trump wants to be involved, particularly now that Alexander is out. Trump really does not need to be involved anymore. Do you know what I mean?

Seth Mandel (29:55)

That's the possible best case scenario, involves that line of thinking, because that's something. I've been turning over my mind also, and I think that everybody has, which is why. Why are. Are the Qataris doing this? Why is Hamas doing this? What are they getting out of it? And obviously, the Qataris are getting lots of really great press, and they're also getting good relationship with the United States President, and they're also getting these business deals. You know, they're getting money out of it, ess, they're getting investments and stuff out of it, and whatever intelligence they can glean from giving the president their own plane. But no, but they have. They are obviously getting some stuff out of it. But it feels disproportionate, if only because if you're Hamas, you have to worry that once Trump has the last living American hostage out, he doesn't care what Israel does to you. That's the. That's the other end of the spectrum. That's the other side of this coin, I guess, to, to mix all these metaphors together, which is it's possible that. That all of this is Trump. Trump is washing his hands not of Israel, but of Hamas itself, and basically saying, I've gotten what I want, what I need to get out of Gaza. There's nothing left there that I need to be constantly involved in the, in the granular way that I've been in the past, and therefore, you know, will be more likely to approve whatever plan the Israelis come up with, because we. We don't feel like we have something to lose if they do it wrong. So that's. But you don't hear anybody talking about that. So you know that. That is not me saying that that's probably the case. Well, I'm just saying that the, the best possible, best case scenario is that idea that Trump now has nothing left to interest him really, in Gospel, except.

Abe Greenwald (31:49)

I would say, to the extent that he feels that the war in Gaza would complicate this list of deals he's looking for in the region. He's very interested. More. More interested than. Than he would be in anything else having to do with Israel.

John Podhoretz (32:08)

He's a very cunning person. Right. Why is Gutter being so accommodating? Why is Gutter giving him a play? Why is Gutter behaving the way that Gutter is behaving as a negotiating substitute? Buying influence. Right? Buying influence with him. Buying influence of Witkoff. Witkoff is somebody they bailed out when he made a failed deal to buy the Park Lane Hotel in Central Park South. He was going to make it into condos. They took it off his hands at a decent price. So now they're all buddy, buddy. That's very nice for him. Congratulations. I think the Gutterys are playing a double game and they're trying to split the right. That's what I think. So I think that the Gutterys are. While this is happening, we also have, of course, the Republicans in the House and the Senate, but mostly in the House, going after elite universities. And elite universities have collected billions of dollars over the last 20 years from Gutter primarily to fund program. You know, it's like every, I think somebody said on Twitter last night was very brilliant. Like every major university in America has an Air Force One sitting on its lawn. It's just not in the form of a plane. It's in the form of the same amount of money that Air Force One cost, but that they got for their Middle Eastern studies program or a building or something or other. And this is their 10 or 20 schools like this across the country that have, have been awash in this money. And Gutter knows that they're in trouble because the Republican Party, the legislative part of the Republican Party, wants to go after their jugular. And they are looking to get the administration on their side as a counterweight to Elise Stefanik and Tom Cotton and others who might really say, okay, who are you people? What are you doing on our campuses? Why are you turning our young, impressionable elite students into enemies of the west and enemies of the United States and enemies of Israel? And so if they can get Trump to say these guys are okay with me, that, of course, complicates matters for the Republicans in the House and the Senate. So the guttery part is very easy, I think, to understand. They are looking to distract, redirect, and complicate the scenario. The narrative about them that has been building now since October 7th.

Christine Rosen (34:45)

Well, and this is actually, it's important, this point about splitting the right, because there's a phrase that I think anyone who's of a mildly conservative sensibility should become more and more familiar with and start wanting to hear from their elected representatives. And that phrase is sovereign wealth fund. Because this is something that I think the influence and reach of these, if you. I think Norway has the largest one because it's of the manufacturing of various drugs and other technologies. But it's China, it's the uae, it's Qatar. I mean, these, these countries use their national wealth to influence what goes on in other countries. It's literally what they do with it. And so that's one of the areas where they also fund people like Tucker Carlson and other sort of right wing influencer types who are making a lot of money pretending that they were having open and free intellectual discussion and just asking questions, but in fact are cashing checks from these nations. So I do think it's important that that become part of the conversation, not just on college campuses, but in terms of how it influences the media that's consumed on the right and even in the middle and all of the ways in which culturally we've talked about China and movies in the past, but culturally there are all these strands in which a lot of this foreign money is having a major impact on American decision making, not just at the policy level, but at the cultural consumption level.

Seth Mandel (36:05)

By the way, just I just wanted to add, Norway sovereign, since you mentioned Norway Sovereign Wealth Fund announced yesterday that they're pulling their investments out of one of Israel's large energy companies.

John Podhoretz (36:17)

So, yeah, nice.

Tevy Troy (36:18)

There's also another point here about the splitting of the right, which is one of the reasons why Trump is pro Israel is because the Republican Party and especially the members in Congress are almost uniformly pro Israel, with the exception of the execrable Thomas Massie. But the Republican base that he needs is pro Israel. And if you could split that, then it makes it a lot easier to back away from Israel. And the Qataris recognize that as well.

Abe Greenwald (36:45)

I just want to add that I think this, Trump's dealing with the Qataris like this weakens his campus crackdown. Right? I mean, how long? I mean, ideologically or, you know, in terms of justifications, like how long before, you know, enemies of the campus crackdown point out that there is, as you say, John, an Air Force One on every college campus and he's doing what these universities, what has been a huge part of the radicalization of the programs in these universities.

John Podhoretz (37:34)

I just don't know who's gonna say, I don't know who's who on the ideological spectrum benefits from making that point. You would have to have a kind of like, well, you left, which we.

Abe Greenwald (37:51)

Don'T have, but it just makes Trump a hypocrite is all. So, I mean, if you frame it that way, and some people do like.

John Podhoretz (38:01)

To do that, I mean, the only thing I'll say is, as I've said before in the past week, you know, if you're an administration, you're a president, you're an executive Branch managing worldwide foreign policy. You have to deal with problematic actors. And how you do that is a 200 year question that involves George Washington having said we are going to be made impure by relations with other countries because we don't want to be part of, of these entangling alliances with these corrupt European potentates. And yet as it turned out, we had no choice because we were going to be a player in the world and we had to have relationships around the world, trading relationships and political relationships and all of that. And then we had the Soviets as a counterweight. We had to deal with countries that were very unsavory but that nonetheless could give us information that we needed or help us in third party channels. That's still the case and that's the ultimate justification for a decent relationship with Gutter, despite its bad behavior, is Gutter can be an intermediary with people we need it to, we need, including messages that we may want to send that are, that are messages we want them to send. Like if he sends a message through Gutter to somebody and saying knock it off or you know, we're going to run a covert op and destroy your oil field or something like that. It's not like that's a bad thing to have somebody who will be able to convey or transmit that message. We had that with the Saudis after 9 11. It's why we were so ginger about blaming The Saudis for 911 is that the Saudis basically came to us and said, we're here to help. We're going to try to do what we can to help you in your goals and aims here. Osama Bin Laden is an enemy of ours as well as yours. Even though he might be a Saudi national. He wants to bring us down. We'll help you bring him down. And we never had a reckoning with Saudi Arabia over its behavior in sponsoring state terrorism over the previous 30 years because they stepped up to the plate when we needed them at a time of crisis. Things are different now. It's 25 years later. I'm just saying this is not something that one should be unsympathetic to, like we can't be Caesar's wife. We are in the world, we have to play around in the world. The question is, what do we do that doesn't corrupt us? And that's of course the ultimate question about this trip and the corruption, sovereign wealth fund investment, the plane, all of that is unnerving people. It is unnerving people on the right. Trump is not aware yet of the nature of how much he is unnerving the right because he does live in a bubble with his sycophantish court around him. And he'll learn. Like, I don't think that plane is ever coming to the United States, as I said yesterday, for various logistical and technical and security reasons.

Christine Rosen (41:15)

But it doesn't, but it doesn't have to, to, to provide some political risk for him because I think it's the accumulation. The plane suddenly got into a lot of people's view in a way that a lot of these smaller, the crypto stuff, a lot of the other smaller stuff that unless you follow politics at a granular level, you weren't even aware of that hit. Now, if there are more of those sorts of things, then I think it is a, it is a political risk for him. Setting aside whether there's actually a legal or ethical breach, the deal making though, remember, he thinks MBS in Saudi Arabia owes him because he had his back after the whole Washington Post reporter murder. So he, and he speaks that way very. He did in his first term. He's like, I had his back, you know, he owes me. So that way of. That's a very easily exploitable position from the perspective of the Saudis. That's why they're rolling out the. Literally giving him the royal treatment, which they know he loves, which feeds the ego. All of these things are in fact strategic on their part. So I think my concern here is we're always hearing from the maga, right? Oh, there's a strategy here. It's long term. You've got to be patient. And some of that is true. But there's also a strategy on the part of our quasi allies, our enemies and, and these hostile states that sponsor terrorism. And we should always be extremely rational about why they're doing what they're doing and how they're targeting Trump and whether or not he is succumbing to some of their charms.

Dr. Rob Williams (42:40)

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John Podhoretz (43:15)

Okay, so let's move to domestic matters. And we have the first report out of the big beautiful bill from the House. We can't go into details about the big beautiful bill. There are some pretty funny aspects to it, like how the no taxes on tips and the no taxes on Social Security last exactly three years before they sunset. So it's sort of like a tip for having no tips for a while, and then it goes away. So theoretically, it's fulfilling Trump's campaign promise, but it ends the minute his administration ends. That's one thing. There are other things, like this whole controversy over the state and local tax deduction salt, and how unnerving this is for the maintenance or preservation of the Republican majority in the House, because there are at least four seats in New York State that could easily flip the other way if this salt deduction, as they call it, isn't wildly increased. Trump killed the salt deduction in the 2017 bill, and except for $10,000 now there's talk of making it $30,000 but capping it at a certain income level and all. And so the people who want the salt deduction are now going to vote against the or saying they're going to vote against the bill because it's not good enough. So this is all interesting. Who knows what will happen? This is just the House vote eventually, and the Senate will chime in and is going to. Not like a lot of it, but a lot of this does violate Republican orthodoxy about free markets and tax policy and all that. But nothing has violated it more profoundly than the statement that Trump made yesterday in the executive order that he issued yesterday on prescription drug prices. And that brings us to Tevi Troy. His article, you know, the Case for Big Pharma or In Praise of Big Pharma, published in, in Commentary and Tevy. So I'm hoping you can lay out for people why, why it is that drug companies that develop these miraculous cures or treatments or whatever, why it happens that countries outside the United States pay less for these drugs, why we pay more, and why somebody like Tyler Cowen, for example, says if this goes through, hundreds of thousands of people will die. So, good luck, you're going to do it. And over time, hundreds of thousands of people will die because you have decided to cap prescription drug prices in the United States. Do you think that's an overstatement? Do you? And what do you make of Trump, even though this is something he said even in the first term? Give us a, give us a sense. Help our, help our listeners understand why they should understand that Trump is playing with fire.

Tevy Troy (46:28)

I'm happy to do it, John, but first I have to give thank you to you because you came to me a couple of months ago and said I should write about this thing about how the pharmaceutical companies, all they do is make life saving, life extending products and all they get is crap. That's basically how you said it to me. And as you've said many a time, Commentary is an editor's magazine. You come up with great ideas and you try and find the writers to do it. So I'm grateful to, to you for this opportunity and it happens to be now the right moment to talk about this issue. And it is true, the American pharmaceutical industry leads the world. They come up with more cures and more life saving technologies than anyone else. We have the opportunity to make even more of them with AI and informatics and the unlocking of the human genome. But unfortunately, the trial lawyers and Hollywood and the Democrats and now the Republicans just dump and dump and dump on this industry. And Tyler Cowen may not even be wrong. He may not even be exaggerating because if cures don't come to fruition, people die. Somebody emailed me this morning, they saw a piece that I wrote based on the pharma piece in the Wall Street Journal and she said that she had breast cancer and she got treatments that would not have existed five years ago. So we do have to recognize the innovation factor here. Now you also raise a good point in saying we do pay higher prices than the rest of the world because the Western European countries impose price controls on the products. They don't let them in unless there are price controls, which means they do pay lower prices, but they also have access to fewer products. They get the access later. And so we, it's true we're subsidizing the rest of the world to some extent and that should be fixed. But at the same time, we have a free market. And if we try and impose price controls, also we will see limits on innovation. And it is true, people will die.

John Podhoretz (48:11)

Now you would say, as you have said many times in the pages of Commentary, writing about healthcare, that our healthcare system is a mess and describing it as a free market is a pretty loose understanding of the term free market. It's a highly regulated market. Government has a lot of power in this industry that it doesn't have in others. First of all, it decides effectively using studies which, which drugs can and cannot come to market. That's one major aspect in which the government plays a key role. But also because Medicare and Medicaid are the two largest, I think, the two largest buyers of medical cures. And they negotiate with, as do the insurance companies, with the drug companies over how much they're willing to pay. There's a lot of intrusion in the market. So the devil's advocate question would be, so Medicare says, I'm not going to pay. We're not going to pay more than $870 a month for this drug. For somebody who has a relatively rare condition, even though you astrazeneca or somebody say that the drug actually costs $25,000 a month to make, we're only going to pay $170 or you're not, you know, or we're not going to cover it all. So why can't we do that across the board? We're doing it already. That would be the. That would be the sort of right. That would be the objection is we're already intrusive in the market. Why can't we do it in a way that is more consumer friendly, even more consumer friendly?

Tevy Troy (49:56)

Well, you are right, of course, that it's not exactly a pure free market. Nothing is, and it is complicated. But in the drug world, we've tended to have a free market in that we allow these drug companies to develop products and then we let them sell them and they generate the price, they come up with a price. Now, it's one thing if Medicare and Medicaid say we're going to negotiate using our leverage as market forces, and I'm totally fine with that. Just like the payers do, the insurers do, the hospitals do. But the other side of it is if you have some kind of government fiat that says you can't pay more than this or this is the mandated price, those are price controls. And that is really different than using market forces to try and come up with the market appropriate price. So there is a distinction there. But you're right, there's a lot of unholy mixing in here that makes it a complicated system.

John Podhoretz (50:47)

So, for example, during the Biden administration, there was this great trumpeting of the fact that the Biden administration had. Was helping the American people by lowering the cost of. Was it diabetes drugs, making sure that you only had to pay $35 a month for your diabetes.

Christine Rosen (51:05)

Insulin.

John Podhoretz (51:06)

Insulin, right. I'm sorry, yeah, diabetes drug. Now we have 2,000 diabetes drugs, actually. So insulin is, you know, is the original, but it's right anyway. And then of course, it turns out that it already already cost $35 a month or 3750 or $38, like whatever the price cap was that they were putting on it, that was effectively the price anyway. So that was one of these like bait and switch games that they were playing to claim they were helping people. Because most people who don't have diabetes and don't need to buy insulin, not that many people are still just using plain insulin, know that the drug had, had, had gone way down in cost because of all this competition. And so Biden could claim this victory out of ignorance, because people were ignorant of the true cost of the drug, which was almost exactly where it was that he was setting it right. So, so there are those games. Is the Trump plan, does it follow? Or could we look at it and say he doesn't really mean it? First of all, it's, he can't just declare it unilaterally and he'll lose in court or whatever. You know, he does, he can't do it. But, but are there circumstances in which you could see them pretty much following the same thing? It's like you're not going to pay, we're not going to let you pay more than $100 a month for X. And that's actually what it costs.

Tevy Troy (52:37)

Yeah. It actually might be an interesting combo of Biden using the rhetoric, saying I did it, but without necessarily the cudgel of the inflation Reduction act, which is how Biden imposed these mandated so called negotiations that gave the drug companies no leverage in the negotiations. But Trump might just be trumpeting that he's saying prices are going to be lower and then he'll point to lower prices because of competition and innovation and say I did it. Because if you do look at the details, such as they are, of what Trump is doing, there's not a lot of details. It's not clear exactly how he's going to do it other than declaring, I want to see prices lower and we have 30 days to show how the prices are going to be lower. Well, great. If it's just a declaration that prices should be lower and the US shouldn't pay as much as these European countries that impose price controls, I'd be okay with that if that's the limit of it.

John Podhoretz (53:29)

So the other thing here is that of course drugs are paid for by health. I mean, a lot of drugs are paid for by health insurance, particularly after the administration that you serve, the George W. Bush administration pushed through Congress the Medicare Part D prescription drug benefit. So 92 or 93% of Americans have health insurance, which is a pretty staggering number. And almost all of them have some form of drug coverage. That is to say, obviously, it's cheaper for someone to take a statin than for a drug for an insurance company. You'd have to pay if somebody has a heart attack and goes into the hospital for three weeks. So what are we talking about here in terms of price controls? Like, let's say we put in price controls and it wasn't terrible. It wasn't like suddenly the drug companies rationed everything and all of that. What kind of savings would individual people actually see because they already have health care coverage through work or through Obamacare or something like that, or Medicare or Medicaid, Would people actually save a lot of money?

Tevy Troy (54:55)

Well, I think this is the point I made in the commentary piece, which is there's a difference between the percentage of total healthcare spending that goes to pharmaceuticals, it's under 10%, and the percentage of pharmaceutical spending that is out of pocket costs. And that has to do with what the insurance companies cover. And so that is a larger percentage. So people see it a bit more, not completely, because as you say, insurance does cover a lot of it, but they do see that there are these price differentials. Even when you go to the drug store and you get a prescription and it is something that you have some coverage for and they say with the copay you pay this, or with insurance you pay this. It's still a larger number than you might see in England. Trump actually was telling that story about his really fat friend who is on Ozempic or something, and he goes to England and it's much cheaper in England than it is here. So, yeah, I mean, there are these differentials and consumers do see it. But you're right, insurance does cover a lot of it as well.

Seth Mandel (55:50)

Would it, would it have any effect on insurance plan prices?

Tevy Troy (55:55)

Unclear because. Yeah, because initially last week when he was talking about it sounded like this was just going to be in Medicaid, the inflation Reduction Act, Biden thing was in Medicare. And then the order that came out was so vague that it could be about Medicaid, Medicare, private insurance, or some combination of all three. So we really don't know the details yet.

John Podhoretz (56:16)

I mean, he does not.

Christine Rosen (56:18)

Yeah, I was just going to ask a question about your piece in particular because I think one of the things. And if listeners haven't read it, they should go read it. You do a wonderful job of tying into the political and economic argument the cultural impact of decades and decades of anti pharmaceutical company messaging. And I think this is what's so fascinating about the particular Moment we're in now because that's now become part of the right. There is a thriving maha subculture, there's a thriving culture of they're sticking it to us, which Trump feeds directly into. You know, the big companies are out to get you. And this used to be the message of a very hostile left who wanted a lot more price controls on just about everything. So I'm wondering culturally, is there a way out of this dead end? Because I was trying. When I was reading your piece, when it first came out, I was trying to think, is there a single movie where the drug is the hero, where the drug cures the kid who's dying? It. No, it's even then it's often the bad pharmaceutical company won't give you access to the drug or it's too expensive, so they have to go elsewhere looking for. To concoct. They're no hero. I mean, it's never the hero. This used to be more of a left coded thing, and now it's right coded as well. So which is bad?

Abe Greenwald (57:31)

Yeah, the drug is the hero. When an individual discovers it, you know, in his spare time or something, you know, devotes. Devotes himself to inventing it.

Christine Rosen (57:42)

Lorenzo's Oil.

Abe Greenwald (57:43)

Right, right.

Tevy Troy (57:44)

It doesn't happen that way if. Of course it happens, because pharmaceutical companies spend billions of dollars. It costs about $3 billion and takes 15 years to bring a product to market. So it's a very expensive, it's a very risky investment. And I'm glad you pointed out the cultural implications, Christine, because there are real implications. If you are constantly demonizing these companies, you're going to have a situation where young people say, well, why do I join that industry? Even if you're a talented scientist, you can go into food scientist or fabric science or any other type of science rather than deal with all the crap you get being in the pharmaceutical industry. And if you're a regulator and you hear how bad these people are all the time, then you're going to say, well, maybe I'm not going to approve their products. I have this story that I got after writing the piece for you and Commentary where this biotech executive said to me, you know, this is so right. I used to go to FDA and we'd have scientific collaboration meetings and it was a friendly atmosphere. And now when I go to fda, I'm met with crossed arms and cold stares. And it's just a very different nature of the relationship between FDA and the drug companies, in part because of this constant hammering on them as evil actors.

John Podhoretz (58:54)

Right. I Mean, so, you know, the most popular new show of the television show of this year is Matlock with Kathy Bates. And the entire plot of Matlock is that she has gone undercover at a law firm to uncover how it played a role in covering up a drug company's role in fentanyl, right?

Christine Rosen (59:18)

And ironically, her slimmed down physique in the show is the result of a drug advancement. So I just want to point that out. She looks great either way.

John Podhoretz (59:25)

So you have this weird thing where the behavior of Purdue Pharma and a couple of others in relation to the alleviation of pain, which went off the rails, right? That there was this entire national consensus that one of the important uses of drug therapies was that they would allow people to suffer less pain. And that this was a key element in the psychic well being of Americans, that if somebody actually felt less pain, they wouldn't want to commit suicide, they wouldn't want to. They, you know, they, they would, they would live a, they wouldn't be afraid of their pain as much, all of that. And then this, you know, and then OxyContin comes along and has this supposedly long shelf, you know, 12 hour shelf life. So you can take it and then it can cover you for 12 hours. And it didn't really work or people abused it. And individual personal agency in the form of adults abusing the prescription drugs that they're taking off, the rules that they were assigned by the doctors who prescribed them somehow fell out the window. You know, everybody just blames the drug companies for this and their marketing and all of that. It has literally nothing to do with any, any of this, right? Has nothing to do with the question of what happens if you develop a drug for Parkinson's that like alleviates Parkinson's or something like that. You spend 15 years, it costs $2 billion. And the number of people who can be cured by it is relatively small, right? It's 15 or 20,000 people whose lives will be saved and transformed by it. But as a result, the drug itself may cost 12, $15,000 a year because the drug companies have to make up what it cost them to develop the drug. And somehow that's evil. You know, that's the cultural impact is that there is now this world in which we can see the cure of all kinds of obscure, very small bore diseases that very few people get that are horrible, right? And they're horrible and horrible to treat. And suddenly there are these new ways of treating them, but the cost of treating them is very high. And then it's going to be. Well, nobody should have to pay that. I mean, that's the bizarre. That's the bizarre part of this, is this notion that somehow you can develop, you can have this industry that develops all this stuff and nobody. In fact, it's immoral to charge people for the cost of something that will be the single greatest improvement in their lives.

Tevy Troy (62:14)

That's the point I make in the article, that there's this perception that pharmaceutical products are a public good, that because NIH spends $47 billion in research that these products should be free or heavily subsidized. But NIH does basic research. They don't do the applied research that actually brings these to fruition. I have to tell one quick, funny story. You mentioned Matlock, and I do list all of the movies and TV shows that have pharmaceutical companies as a villain. And a very close friend of mine who's a very smart doctor and a commentary reader said to me, you know, I really liked your commentary piece. But. And whenever I hear the but, I get nervous. He said, but I can't believe you watch Matlock, which I don't actually watch, but John pointed it out to me it was for research.

Seth Mandel (62:58)

Is there any way I watch it.

John Podhoretz (63:00)

Because I'm in my 60s and it's the law. I am obliged to watch Matt. I'm obliged to watch Tracker and anything on cbs. They, they, they send out signals if you get over 60 that make you watch them even when they're incredibly stupid and boring like Tracker. I can't help myself. I don't know how they do it. It's really horrifying. And maybe we should do an investigation and make all of that free.

Seth Mandel (63:29)

If only you were in the UK where they mandate everybody watch Adolescence instead of Matlock.

John Podhoretz (63:36)

Okay, well, time, time is upon us. Gotta say goodbye till tomorrow. Thanks as always to Tevy Troy for his insights and his article. Again, Abe, I'm having that senior moment that makes me a CBS viewer. Is Tevy's article In Praise of Big Pharma or the case for Big Pharma? Do you remember?

Christine Rosen (64:00)

In praise.

Abe Greenwald (64:00)

Yeah, in praise.

John Podhoretz (64:01)

Praise of Big Pharma. Okay. So in Praise of Big Pharma in our May issue. May issue. Okay, so. And please read it and learn from it and understand why what Trump is up to here is something that no conservative should, should be in even the remotely comfortable with, not only economically, but also in terms of American health, American outcome. American health outcomes comes and all of that will be back tomorrow for Christine, Seth and Abe on Chompod Hor Keep the candle burning.