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While communities with high unemployment and depressed areas like Rocky Mount in N. Carolina, with 14% unemployment -and many customers skipping prescriptions because they can't afford them- are the worst off, the national picture shows many similiarities. Even with Medicare drug benefit, lowcost generics, and Walmart type low cost drugs, many Americans cannot afford prescription medications for life threatening illnesses. Nationally a third of respondents say they are not complying with prescriptions as they cannot afford them, compared to a fourth three years ago.

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How the discount drug programs at the big drug store retail chains like CVS. Walgreens and Walmart are leading to increasing competition and lower prices in generic drugs that are now sold for one month supplies for hundreds of unbranded drugs. Mass mechandisers like Target have their own programs selling drugs in the same manner as the Walmart which started this with its $4 generic prescriptions for one month supplies in 2006. Its changing the landscape for drug pricing gradually and will become part of a larger trend as health care costs are challenged in different ways by customers, merchandisers, and others in a low inflation cost conscious economic environment, with an overstretched indebted consumer looking for ways to cut costs on everything from groceries, shopping needs and prescription drugs.

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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Chris Klomp, 45 years, takes over at 65,000 person $2.6 trillion government agency, Department of Health and Human Services, as Counselor, as Robert Kennedy Jr. heads for the campaign trail in addition to HHS duties March 12 2026. He impressed DJT with his negotiating ability against the drug companies in the government's efforts on Affordability of medicines. DJT calls him "my favorite Mormon." Susie Wiles was looking for a stabilizing force at HHS after vaccine controversies and wants the message to focus on improving health and cutting costs. Robert Kennedy Jr says about Klomp- "He is moving quickly to impose operational discipline, sharpen our strategic direction, and fortify a renewed sense of mission and accountability.” Klomp is pulling together all the agencies under HHS including FDA and others. Klomp takes his role seriously to cut costs and improve Health- .“In health care in particular, I do believe that I’m my brother’s keeper, and our job is to do the very best that we can for the people that we serve — the American people.” ...

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The FDA approves Governor De Santis proposal for importing drugs from Canada. Colorado is one of the other states that have applied. The drugmakers continue their opposition even if this means lower prices for the American people of excessively higher priced American drugs compared to other countries. Both Republicans and Democrats agree prices have to come down and support importing of drugs into the US, then why is it taking so long for the FDA  to approve state proposals? The Biden administration has issued an executive order for the FDA to work with states on this.

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Media pays little attention to the costs of intermittent wars 1970 to 2026 and lost opportunities for economic development and modernization of a whole range of countries in the Middle East from the area around Egypt, and North Africa including Libya, Sudan, the region around Arab part of the Ottoman Empire of Iraq, Syria, the region stretching from Iran to the Gulf, Pakistan and Afghanistan. As Asia advances in modernization this area and the areas in parts of Latin America that are affected by "drug states" within states are severely impacted. Even the oil dividend is time bound as it lapses in the Middle East with the transition to renewable energy that is only likely to accelerate between 2026-2035. It reflects a series of poor choices by a whole generation of leaders in these regions.

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The Economist quotes experts saying that drug innovations would not be affected by price controls on drugs. Pricing reforms can accomplish the reverse, spur innovation by doing as Britain and Germany are doing- pioneering comparitive reviews of drugs effectiveness and cost-benefit analyses aimed at reimbursing firms for new drugs based on their performance. Sanford Bernstein, a financial advisory firm, says in its study that a 20% reduction in what Medicare pays for drugs would not kill off innovation, it would reduce earnings per share of big pharma firms by 3-8%. As drug research is now done in many countries, and its a globalized industry, innovation is not likely to be automatically affected by price reductions in one country like the USA, according to Alna Garber of Stanford University and Patricia Danzon of Wharton Business School.

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The EU's competition commissioner to crackdown on pharmaceutical companies that are delaying the entry of generics drugs with various tactics that are anticompetitive. EU has raided the offices of several marge drug companies and retrieved documents that show this activity was going on. About 5% of medical bills or 3 billion euros coud have been saved from 2000 to 2007, if companies had allowed generics to enter the market earlier and not resorted to these antitcompeitive strategies. Like paying off generics companies or having so many patents on the ingredients of the drug, in one case 1300 patents on one single drug, and then suing the generics companies to tie up the case in the courts.

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Achieving a right balance between the needs for public health in developing countries- and the need for cost reduction in developed countries- with the need to keep innovation, is the challenge facing the Indian Supreme Court as it hears the Novartis case on its leukemia drug Gleevec. The efforts by Novartis and other western pharmaceutical companies to restrict the flow of low cost generic drugs from India. India stopped granting patents on drugs in 1970. It only resumed giving patents under a WTO agreement on patents. The Indian government denied the patent on Gleevec and the case is now coming up before the Supreme Court.

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Medicare price negotiations begin under the Inflation Reduction Act. Of this legislation president Biden says- "There is no reason Americans should be forced to pay more than any developed nation for life saving prescription drugs just to pad Big Pharma's pockets." Incomprehensibly this law that cost Americans hundreds of billions of dollars was passed by the younger Bush in 2003 banning Medicare from negotiating prices of drugs. It thrust one of the biggest boondoggles in postwar history on the American people under an equally incomprehensible name "Act for Drug Improvement and Modernization," with the idea that it was a form of government price controls. 

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The US Justice Department imposes a $225 million fine on Teva Pharmaceutical and requires it to sell its Pravastatin drug line as part of a deferred prosecution settlement on price fixing charges. The  public was overcharged by $350 million according to a 2020 indictment. Collective fines on price fixing charges in the generic rugs industry amount to $680 million reports WSJ. Teva will also have to donate $50 million to needy patients. This is another way the Biden Justice Department is bringing down the cost of living by keeping a close eye on drug costs pushed up by illegal price fixing. 

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Democrats continue to believe they lost in 2024 because they did not attack DJT enough. This fails to cite issues such as cost of living- surge in the third year of the Biden administration with 20% increase in prices and Biden failing to take notice and address this quickly. A wave of illegal immigration- the failure of Mayorkas, himself a Cuban immigrant in 1960, put in charge of Homeland Security and ICE, and Harris who was an attorney helping indigents in inner city San Francisco, to grasp the fears of border states and southern states. The failure to understand that the border was open and inviting waves of illegal immigrants, some with questionable backgrounds. This issue created a sense of unease in the fabric of society and American people. Other issues simply showed how Harris could not relate to the conservative people and average people in the country in the cultural aspect such as transgender, rural America. Biden pulling out suddenly, loss of rural vote- failure of Democrats since Obama to pay attention to rural voters, Harris not appealing to the white male vote in the US, are other factors that hurt Democrats. DJT gained with the shooting incident in Pennsylvania in which he survived, and the perception raised during a garbage truck and DJT photo that the Democrats derided, seen by the public as looking down on working class people. Democrats never really grasped how the political system had gone in reverse- the Republicans had put cultural aspect first and conservative now meant working class voters and white voters in rural areas/small towns, big cities, ( the Archie Bunker type of an earlier era who was now a Democrat, not the college educated and Ivy league Harvard type that had taken over the Democratic party). This continues to this day with some paradox as the business class and the billionaire class sit alongside the working class person in the Republican party DJT created. DJT did this in 2016 by pulling together workers hurt by Bush and Obama's policies favoring the educated classes and affluent, ignoring rural areas and farmers, and committing US to wars in the Middle East that squandered the Nations' resources and human lives. This was aggravated in the Biden/Harris/Mayorkas years by letting in migrants across the border by the millions that created a great deal of unease in the working classes. In this way labor unions or their rank and file left the Democratic party- a problem that plagues Democrats to this day, that Biden tried but failed to fix. The border issues had become complex by the latter part of the Biden administration because of the complete collapse of Venezuelan economy and the drug cartels in Mexico smuggling people and drugs across the border, for which the Biden administration or Harris had no answer.  It was the failure of administrations to continue the Monroe Doctrine in the form given by FDR as "Good Neigbor Policy," and JFK as the Alliance for Progress, allowing drug cartels and foreign European powers to intervene in the western hemisphere, desorying good governance in Mexico, Venezuela, Cuba and other nations in Latin America. By the second year of the DJT administration Venezuela, and the border were brought under control, and the situation in Mexico put in a new direction. ...

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The Trump administration is taking aim at drug costs under Medicare inflated by deals pharmaceutical companies make with industry go-betweens.  These are the secret deals of pharmaceutical companies with pharmacy benefit managers who negotiate the price of drugs for insurers and employers.

Under the proposal pharmacy benefit managers lose the legal protections that let them take rebates from drug companies.

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India US trade relationship needs a complete rethinking in 2025 as trade tensions increase. In addition India needs to accept that the US or some other power has to maintain peace from a possible nuclear escalation that would be so damaging to south Asia and the world, and the US role under DJT seen in this context and welcomed. For this to happen both US and India need to look beyond the past perceptions of ethnic divisions as India industrializes, beyond China, as India's modernization will change everything in Asia and the world. Possible opportunities exist in India offering it's strengths in pharmaceuticals to reduce costs of drugs to ordinary Americans. India could take advantage of the reduction in oil prices under DJT to reduce purchases of Russian oil so that it is getting nearly the same price when oil prices were high and Russia offered discounted oil.  On agricultural exports to India, India can look for better ways to tackle this offering some transition period to when the US could send some quantities of exports in areas where India's rapidly growing middle class can absorb US fruits production such as cherries and apples, other fruit. India could help the US in the pharmaceutical and other sectors as a way to address US desire for reducing costs of drugs in the US. India could for instance make the drugs at a low cost in the US, investing in factories in the US to supply low cost drugs to average Americans tackling one of the biggest problems the American people face. ...

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China's healthcare costs have increased in the last decade without effective cost control measures. With the decline in consumer spending in the last decade to where it is now only 35% of GDP, and ordinary Chinese setting aside a large portion of savings for costly drugs and healthcare, reducing healthcare costs is a high priority to rebalance the economy and increase consumer spending. By comparison in the U.S. it is 70%. Bussey points out the importance of this for the new leadership of Jinping-Keqiang in China. Xinhua, the Party offical news agency, expressed China's new policy, saying that "some believe China may see a nationwide price cut on medicines." Regulators have begun probes of Nestle and Danone for possible anticompetitive activity and the two companies dropped prices for baby formula.

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On world tuberculosis day the work of Dr. Zarir Udwadia is acclaimed for drawing attention to a resurgent tuberculosis in India through a medical journal article in 2012 for untreatable TB. India has 2.8 million new TB cases annually, 100,000 being drug resistant, according to WHO. India relies on outdated diagnostic tests that miss about 50% of the cases and Dr Udwadia says India needs newer technologies including GeneXpert tests. TB can be easily treated at a cost of $5 with 4 drugs over 6 months if done in time. Wrong drugs, incorrect doses, irregular medication, lets the TB bacteria become resistant causing havoc- leading to taking of 250 injections and 15000 pills treated for upto 2 years and costing thousands of dollars, with the toxicity of the drugs levels creating risks of deafness, blindness, kidney failure, and psychotic conditions. Crowded conditions in slum areas act as an incubator of the disease and infection rates, with 20 people being infected by one patient alone. ...

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President Biden removes one of the costly boondoggles thrust on the American people with Bush's Drug Improvement and Modernization Act of 2003, which was anything but an improvement. .The following are the 10 pharmaceutical drugs that will be negotiated for Medicare prices under the Inflation Reduction Act- Eliquis and Jardiance (strokes), Jardiance, Xarelto (diabetes), Entresto (heart failure), Enbrel (arthritis). Laws passed under Republican president younger Bush incomprehensibly took away the right of the government to negotiate drug prices with pharmaceutical companies in one of the most egregious and costly decisions in postwar history by the government of the United States. It has only aggravated the problems and cots of healthcare for the American people. President Biden reversed this with the passage of the Inflation Reduction Act during the pandemic. Strangely it is part of the real culture war in America in which about 80% of both Republicans and Democrats support this but the media allowed the Bush legislation to be passed without saying it made no sense to say this negotiation was a form of price controls by the US government. This is how low the US policymaking had fallen by 2003 with legislators and press unable to make a simple point. Bush's legislation was called even more incomprehensibly the Medicare Drug Improvement and Modernization Act, when it was one of the biggest financial disasters for the American people costing them hundreds of billions of dollars in their savings and incomes to pay inflated prices of pharmaceuticals that people in Europe and Asia (India and China) were not paying.  ...

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Brian Deese and other economists remind us that the government is still not able to negotiate the prices of drugs with pharmaceutical companies something that government was instructed not to do under a Republican administration with a George W. Bush administration rule that has hurt millions of Americans since 2003. In fact December 3, 2003 may be a day of ignominy for Americans who face high cost of pharmaceutical drugs, and actions that send money from the pockets of government that would go into fixing aging infrastructure, and from pockets of ordinary Americans that would go into meeting the cost of living to improve ease of living. President Biden without the needed majorities in Congress was able to only specify certain drugs on which negotiation could take place. There is a need to cut pharmaceutical costs for the American public, there is a need to be like everybody else in the community of nations in Europe and Asia that pay only so much for pharmaceuticals not many times more. Making the US worse off than Indians and Chinese who can access these drugs and find it affordable for most of the people of 3 billion in these countries. The contrast makes one question what is a developed and a developing country as what has happened in the last 3 decades in America has turned this  question on its head- with irresponsible presidents and irresponsible Congress. ...

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Jeanne Whalen on the Two Speed Economy in the US September 2025- diverging paths of low and high income Americans. With the new administration in 2025 priorities shift to immigration and what to do about 14 million illegal migrants from Latin America and other places, war on fentanyl and drug trafficking gangs with hundreds of thousands of lives lost to fentanyl and drugs in the US, crime and safety which includes the unprecedented illegal movement of drug trafficking in the Nation, and to a bold posture on using US advantages of its huge market to get European Union, Japan, South Korea, and China to level the playing field on trade bring jobs home.The Biden administration had already conceded to DJT's approach in its one term presidency by shifting on uncontrolled illegal migration but not fast enough, by not removing DJT's tariffs, and failing to take an aggressive posture on fentanyl and drug trafficking. Of the DJT plan US has tariff based revenues of 10--15% for all countries imports into US can that it redirect to groups to soften any effects of tariffs. DJT administration oil transition policy of stretching out the transition to give middle class and lower classes cost of living relief was also accepted by the Biden administration and is now the policy of Democrat run California state government.  The US economy was slowing in 2024 under the Biden administration. What has changed in 2025 is that the US stock markets are responding to steps taken by the DJT Republican administration to lower the cost of doing business by softening regulations, and giving US business the upper hand in different industries, and rebuilding the manufacturing sector with calls for EU and Japan/South Korea to invest more in the US as a quid pro quo for market access. This has led to increase in the value of market portfolios of the income earners above 250,000, or 10% of American households. As this happens the process of trade renegotiation has introduced some uncertainty in 2025 and businesses are looking for more clarity before increasing investment and slowing job hiring which hurts younger people entering the job market and lower income Americans. Were things better under Biden? Government Covid assistance and payouts in the early years 2020-2021 helped lower income workers, as this faded and the cost of living autos, housing increased sharply under Biden in 2022-2024 the situation deteriorated. The situation today is similar to the situation in 2024 with the difference in 2025 that inflation is coming down just as government help is receding. And added factor is the DJT administration plan to tackle head on the increasing cost of Medicaid to about $1 trillion by adding new requirements and reducing subsidies. The federal workforce had a disproportionate share of black workers and the policy changes to reduce the federal workforce have increased black unemployment from 6.1% under Biden in August 2024 to 7.5 % a year later. Hispanics have seen slight improvement in unemployment to 5.3% in 2025, and the middle class incomes also have held up and are holding steady. Meantime Bloomberg points out that one third of people in the top 10% are living paycheck by paycheck because of high cost of housing, university education for children, and inflation.     ...