>Trump threatens to repeal the ACA, but he also talked about negotiating a better bulk purchase Medicare deal with Big Pharma and other suppliers. Truly massive US markups should allow a competent negotiator to secure an immediate at least 20% drug cost deflation, dropping the deficit by considerably more than that because of the way deficit is calculated. And that's just the beginning when US prices can be more than 1000% of prices paid elsewhere.
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>Unfortunately cost deflation of up to 50%, or mega-inflation of the US dollar, now are the only ways to cover an essentially unpayable Medicare deficit.
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>So Trump's negotiation idea makes sense- except that in 2003 the (Republican) Congress passed an act preventing federal government using its negotiating power to reduce Medicare supplier prices. Not sure why this isn't all over the media, because the current Republican Congress would need to repeal this law before Trump legally can negotiate Medicare rates, which I think is why his Jan 31 meeting with Big Pharma execs didn't seem to do much at all.
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From my uninformed POV the best a shrewd negioator would do is discuss ramifications of dropping all hurdles keeping US customers (patients, pharmacies and hospitals) from buying drugs abroad and thereby establishing a real market. As this is directly in contrast to import dues and (perhaps) "Buy American", such bargaining is more difficult for Trump... Although with his tendency for fogging the issues he might try and succeed ;-)