In his inaugural address, President Donald Trump vowed to end the chronic disease epidemic and keep America’s children healthy and disease-free. An important step begins abroad, pressuring other wealthy countries to abandon policies that restrict access to lifesaving medicines, ensuring chronically ill patients receive the treatments they need.
Chronic diseases, such as diabetes, cancer, and cardiovascular disease, pose one of the most significant health threats to Americans today. The share of Americans with multiple chronic conditions increased from 21.8% in 2001 to 27.2% in 2018. In 2022, these illnesses claimed the lives of 1.9 million Americans, accounting for eight out of the 10 leading causes of death.
High-quality prescription drugs are among the most effective treatments for chronic diseases. Pharmaceutical products can reduce the severity of patients’ conditions so they can live longer and healthier lives with fewer medical expenses — every dollar spent on medications for diabetes and congestive heart failure can save $3-$10 on emergency room and inpatient hospital visits. A study published in 2022 found that overall, prescription drugs are responsible for 66% of the increase in longevity in the United States between 2006 and 2016. Imagine the difference treatments not yet available might make.
Unfortunately, many countries undermine the development of prescription drugs. Just as many nations underfund their defense budgets and rely on the United States to shoulder the cost of global security, these same countries also refuse to pay fair market prices for pharmaceuticals, leaving Americans to bear the brunt of drug development costs.
Through a practice known as global freeloading, other wealthy countries leverage their socialized health care systems to negotiate steep discounts from drug manufacturers. On average, these countries pay just 24 cents for every dollar Americans pay for pharmaceutical treatments. In 2018 alone, price controls reduced drug sales in other wealthy countries by 77%, or $254 billion. This freeloading allows other countries to enjoy the benefits of American drug innovations, without paying the necessary costs to develop them.
While these sweetheart deals are politically popular abroad, they directly harm American health. Here’s why: Drug manufacturers care about market size. On average, every $2.5 billion increase in global drug sales to treat a specific disease incentivizes those manufacturers to develop an additional new drug for the same condition. When other countries systematically underpay for drugs, the global market shrinks. As a result, drug manufacturers develop fewer drugs, and chronically ill patients often languish as their conditions worsen.
America can fix this. If other countries pay market-based prices, drug manufacturers could invest more dollars to invent and produce new lifesaving drugs. A 2018 study estimated that removing drug price controls in other developed countries would cause drug manufacturers to produce eight to 13 additional drugs per year by 2030, potentially extending average life expectancy by nearly one year. Increasing foreign drug sales revenue would also provide drug manufacturers with greater financial capacity to reduce drug prices for American patients.
The Trump administration could leverage policies such as the International Price Index and Most Favored Nation pilot programs to encourage other countries’ investment in greater drug development. First proposed in Trump’s first term in office, these policies limit how much Medicare pays for the most expensive drugs based on their prices in similar wealthy countries. Once Medicare aligns America’s drug prices with those in other countries, drug manufacturers could no longer rely solely on Americans to finance drug development. The result: These companies would have to terminate sweetheart deals with low-paying countries and make sure they pay higher prices to support chronically ill patients.
The White House could also leverage the Office of the United States Trade Representative (USTR) to pressure other countries to abandon freeloading. During President Trump’s first term, USTR imposed tariffs on China, seeking a commitment to ending unfair trade practices that harmed Americans. While the Biden administration failed to adequately enforce China’s commitments, USTR’s actions demonstrate a proof-of-concept that tariffs can encourage countries to end policies that threaten America’s interests. Similarly, the agency could leverage its tariff authority to encourage other wealthy nations to pay higher prices to support drug development.
Drugs save millions of lives every year and could save many more if sweetheart deals and freeloading weren’t stifling innovation. By combatting this and getting the global community to pay its global fair share for pharmacological innovation, Trump can improve the lives of millions of sick Americans while empowering drug manufacturers with more resources to lower pharmaceutical prices in the U.S.
Bobby Jindal served as governor of Louisiana (2008–16) and as a U.S. assistant secretary of Health and Human Services (2001–03). Charlie Katebi is deputy director of the Center for a Healthy America at the America First Policy Institute.