>>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 ;-)

It's easy and popular to sling off at Trump, but what about the dumb dumbs on both sides of the house that watched US healthcare prices surge ridiculously year after year? So-called Obamacare was the first serious effort to rein costs in and it was blocked and weakened by obstructionist Republicans.

What about the dumb dumbs who *must* have known how important individual mandate is for any insurance system that isn't allowed pre-existing exclusions, refusals or rescisions? Those dumb dumbs squabbled and postured as inadequate delayed penalties predictably caused insurers to lose money and push up premiums and force the system into the insurance death spiral.

At least Trump is willing to grasp the nettle and hopefully make use of majorities in Congress and Senate to effect change. He's grasped a lot of nettles in his first month in office and every time he does grasp a nettle, media people are standing by to guffaw if he winces or alters grip, forgetting that the 4th Estate did a lousy job protecting the people as these problems were manufactured so while it's nice they're waking up now, how about arguing the point, not the man?

Has Trump made mistakes? As they say, if you don't make any mistakes you're not making anything, and Trump is moving very quickly. I can't find anywhere in the partisan MSM that lists the things he did so far compared to what other presidents did in their first month. My pick: eventually somebody will produce a list and the MSM will ignore it because it makes their preferred "best ever" president look lame.

I hope Trump does honor his pledge to target overpriced pharmaceuticals, but drug costs have been stable at about 10% of overall healthcare spend for many years and you can't save the required 25-50% by focusing only on 10% of costs. The good thing about finally grasping this nettle is that gradually but inevitably, the biggest contributors to overpricing will be forced into disinfecting sunlight. Some are predictable, but others may surprise - e.g. if hospitals are thought of as medical hotels selling beds and services, are US facilities operating as efficiently as facilities abroad? I'm not talking about the push to savings through daystay, but to bed utilization and return on capital. Suffice to say that while some are very efficient, others show awful efficiency that drives up the per episode cost. Prices are so inelastic that a community needing 100 beds can have 300 beds in partially full competitors that charge high prices to maintain returns. Once this one gets sunlight, Trump can engage the industry on a topic he knows very well. I just hope the MSM will pause long enough in their attacks on Trump to actually do their job as 4th Estate.