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Trump signs executive order aiming to slash prescription drug costs up to 90%

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“Most powerful executive order on pharmacy pricing and health care ever in the history of our nation.”

President Donald Trump hosted a press conference with Secretary of Health and Human Services Robert F. Kennedy, Jr., and other health administration officials Monday morning formally announcing an executive order aiming to drastically reduce what Americans pay for their prescription drugs up to 90%, according to Trump.

The order seeks to reform how much the U.S. pays for pharmaceutical drugs compared to other countries. On average, Americans pay nearly four times more than other countries for their prescription drugs, effectively subsidizing pharmaceutical companies’ research and development costs for others around the world, according to the administration.

The order was immediately met with skepticism by some critics.

“If Trump is serious about making real change rather than just issuing a press release, he will support legislation I will introduce to ensure we pay no more for prescription drugs than people in other major countries,” Sen. Bernie Sanders, I-Vt., posted on X after the press conference, touting his own legislation and saying Trump’s order will be “thrown out by the courts.”

“If we come together, we can get it passed in a few weeks,” Sanders said.

Food and Drug Administration Commissioner and Johns Hopkins surgical oncologist Marty Makary was one of the officials who spoke at the press conference Monday morning.

“We didn’t take an oath to heal patients and then watch their life get ruined financially with their home, mortgage, retirement going down the drain with Go Fund Me campaigns, raising money from church communities and synagogues and friends they haven’t seen in 20 years to try to raise money – for what?” said Food and Drug Administration Commissioner Marty Makary.

“For a system where Americans have been getting ripped off by 10, 12, 15 times higher prices than we see in other countries?”

Makary and others said the “fundamental problem” with American prescription drug costs is a lack of competition in the global marketplace, with Americans comprising only about 4% of the global population but supplying at least two-thirds of drug companies’ revenue globally.

“The fundamental problem in health care is that we’ve had non-competitive markets,” Makary continued. “We can do little things around the edges, or we can transform those markets into competitive markets, and that’s what this executive order does.”

The order intends to secure the “most-favored-nation” price for pharmaceutical drugs for the U.S., or the lowest price among its economic peer countries, through a series of actions. It instructs the U.S. secretary of commerce and the U.S. trade representative to “ensure” that other countries aren’t engaging in practices that “[force] American patients to pay for a disproportionate amount of global pharmaceutical research and development.” Kennedy is to work in coordination with Centers for Medicare and Medicaid Administrator Mehmet Oz and others to develop most-favored-nation target pricing for pharmaceutical companies. It also directs Kennedy to devise direct-to-consumer purchasing programs for drug companies that abide by the president’s most-favored-nation pricing mandate for the U.S.

Oz called the order the “most powerful executive order on pharmacy pricing and health care ever in the history of our nation.”

If drug companies don’t comply, then the order directs Kennedy to create a rulemaking plan to impose the targeted pricing, or certify to Congress that the U.S. can import the drugs that remain too expensive under certain importation waivers. Certain drugs may even have their FDA approvals revoked by Makary.

Kennedy said some politicians, including Sanders, have been promising to “equalize” what the U.S. and Europe pay for pharmaceutical drugs for years, while knowing they can’t deliver on the promise because of the deep entanglement between the pharmaceutical industry and Congress. And even though he too has been promising to do something about the issue for years, he didn’t think he would see a solution emerge in his lifetime.

“I’m just so grateful to be here today. I never thought this would happen in my lifetime,” Kennedy said. “I have a couple of kids who are Democrats, who are big Bernie Sanders fans. When I told them what was going to happen, they had tears in their eyes, because they thought this was never going to happen in our lifetime.”

Kennedy and the other health administration officials who spoke praised the president for being willing to stand up to the industry and its powerful lobby, which has one to three times as many lobbyists in Washington as there are members of Congress and the Supreme Court, according to Kennedy.

“We finally have a president who’s willing to stand up for the American people,” Kennedy said.

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Addictions

Canada must make public order a priority again

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A Toronto park

Public disorder has cities crying out for help. The solution cannot simply be to expand our public institutions’ crisis services

[This editorial was originally published by Canadian Affairs and has been republished with permission]

This week, Canada’s largest public transit system, the Toronto Transit Commission, announced it would be stationing crisis worker teams directly on subway platforms to improve public safety.

Last week, Canada’s largest library, the Toronto Public Library, announced it would be increasing the number of branches that offer crisis and social support services. This builds on a 2023 pilot project between the library and Toronto’s Gerstein Crisis Centre to service people experiencing mental health, substance abuse and other issues.

The move “only made sense,” Amanda French, the manager of social development at Toronto Public Library, told CBC.

Does it, though?

Over the past decade, public institutions — our libraries, parks, transit systems, hospitals and city centres — have steadily increased the resources they devote to servicing the homeless, mentally ill and drug addicted. In many cases, this has come at the expense of serving the groups these spaces were intended to serve.

For some communities, it is all becoming too much.

Recently, some cities have taken the extraordinary step of calling states of emergency over the public disorder in their communities. This September, both Barrie, Ont. and Smithers, B.C. did so, citing the public disorder caused by open drug use, encampments, theft and violence.

In June, Williams Lake, B.C., did the same. It was planning to “bring in an 11 p.m. curfew and was exploring involuntary detention when the province directed an expert task force to enter the city,” The Globe and Mail reported last week.

These cries for help — which Canadian Affairs has also reported on in TorontoOttawa and Nanaimo — must be taken seriously. The solution cannot simply be more of the same — to further expand public institutions’ crisis services while neglecting their core purposes and clientele.

Canada must make public order a priority again.

Without public order, Canadians will increasingly cease to patronize the public institutions that make communities welcoming and vibrant. Businesses will increasingly close up shop in city centres. This will accelerate community decline, creating a vicious downward spiral.

We do not pretend to have the answers for how best to restore public order while also addressing the very real needs of individuals struggling with homelessness, mental illness and addiction.

But we can offer a few observations.

First, Canadians must be willing to critically examine our policies.

Harm-reduction policies — which correlate with the rise of public disorder — should be at the top of the list.

The aim of these policies is to reduce the harms associated with drug use, such as overdose or infection. They were intended to be introduced alongside investments in other social supports, such as recovery.

But unlike Portugal, which prioritized treatment alongside harm reduction, Canada failed to make these investments. For this and other reasons, many experts now say our harm-reduction policies are not working.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist recently told Canadian Affairs.

Yet, despite such damning claims, some Canadians remain closed to the possibility that these policies may need to change. Worse, some foster a climate that penalizes dissent.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” Rieb said.

Second, Canadians must look abroad — well beyond the United States — for policy alternatives.

As The Globe and Mail reported in August, Canada and the U.S. have been far harder hit by the drug crisis than European countries.

The article points to a host of potential factors, spanning everything from doctors’ prescribing practices to drug trade flows to drug laws and enforcement.

For example, unlike Canada, most of Europe has not legalized cannabis, the article says. European countries also enforce their drug laws more rigorously.

“According to the UN, Europe arrests, prosecutes and convicts people for drug-related offences at a much higher rate than that of the Americas,” it says.

Addiction treatment rates also vary.

“According to the latest data from the UN, 28 per cent of people with drug use disorders in Europe received treatment. In contrast, only 9 per cent of those with drug use disorders in the Americas received treatment.”

And then there is harm reduction. No other country went “whole hog” on harm reduction the way Canada did, one professor told The Globe.

If we want public order, we should look to the countries that are orderly and identify what makes them different — in a good way.

There is no shame in copying good policies. There should be shame in sticking with failed ones due to ideology.

 

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Business

Canada’s health-care system is not ‘free’—and we’re not getting good value for our money

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From the Fraser Institute

By Nadeem Esmail and Mackenzie Moir

In 2025, many Canadians still talk about our “free” health-care system. But in reality, through taxes, we pay a lot for health care. In fact, according to the latest data, a typical Canadian family will pay $19,060 (or about 24 per cent of their total tax bill) for health care this year.

Given the size of that bill, it’s worth asking—do Canadians get good value for all those tax dollars? Not even close.

First, Canadians endure some of the longest wait times for medical care—including primary care, specialist consultations and non-emergency surgery—among developed countries with universal health care. In fact, the wait in Canada for non-emergency care is now more than seven months from referral to treatment, which is more than three times longer than in 1993 when wait times were first measured nationally.

Why the delays?

Part of the reason is the limited number of medical resources available to Canadians. Compared to our universal health-care peers, Canada had some of the fewest physicians, hospital beds and medical technologies such as MRI machines and CT scanners.

And before you wonder if $19,000 per year isn’t enough money for world-class universal coverage, remember that Canada has one of the most expensive universal health-care systems in the developed world, which means Canadians are among the highest spenders on universal health care yet have some of the worst access to health-care services.

Fortunately, countries such as Switzerland and Australia, which both provide far more timely access to high-quality universal care for similar or even lower cost than Canada, offer lessons for reform. Compared to Canada, both countries allow a larger degree of private-sector involvement and, perhaps more importantly, competition in their universal health-care systems.

In Switzerland, for instance, health insurance coverage is mandatory and provided by independent insurers that compete in a regulated market. Swiss citizens freely choose between insurers (which must accept all applicants) and can even personalize some aspects of their universal insurance policy. Patients also have a choice of hospitals, more than half of which are operated privately and for-profit.

In Australia, citizens can purchase private insurance, which covers the cost of treatment in private hospitals. Higher income Australians are actively encouraged to purchase private health insurance and even have to pay additional taxes if they do not. Some 39 per cent of hospitals in Australia are private and for-profit, providing care to both privately and publicly insured patients.

Vitally, competition between private health-care businesses and entrepreneurs in both countries (and many others including Germany and the Netherlands) has helped create a more cost-effective and accessible universal health-care system. Back here in Canada, the lack of private-sector efficiency, innovation and patient-focus has led to the opposite—namely, long waits and poor access.

Health care in Canada is not free. It comes with a substantial price tag through our tax system. And the size of that bill leaves less money for savings and other things families need.

Getting better value for our health-care tax dollars, and solving the longstanding access problems patients face, requires policy reform with a more contemporary understanding of how to structure a truly world-class universal health-care system. Until that reform happens, Canadians will continue to be stuck with a big bill for lousy access to health care.

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