The Free Market That Isn’t: Trump, Big Pharma, and the Price of Courage

Charlton Allen is an attorney, former chief executive officer, and chief judicial officer of the North Carolina Industrial Commission. He is the founder of the Madison Center for Law & Liberty, Inc., editor of The American Salient, and the host of the Modern Federalist podcast.

Mr Allen has penned a response to the many who claim that President Trump's 'Most Favored Nation' pharmaceutical pricing XO 14297 is anti free market:

https://www.americanthinker.com/articles/2025/05/the_free_market_that_isn_t_trump_big_pharma_and_the_price_of_courage.html

The Free Market That Isn’t: Trump, Big Pharma, and the Price of Courage
By Charlton Allen - May 16, 2025

President Trump’s bold move to rein in prescription drug prices is already drawing the expected cries of “price controls” from the usual suspects. They throw themselves between the industry and reform like lobbyists in pinstripes, warning of creeping socialism, invoking Ronald Reagan while defending the most cartelized, subsidized, and globally manipulated sector in the United States: pharmaceuticals.

Let’s get something straight. There is no free market in prescription drugs. None.

And Ronald Reagan was never faced with a Danish pharmaceutical company charging Americans $1,000 or more for a 30-day supply of critical medication, while selling it to Europeans for a fraction of that price. But if he had, he would’ve stopped it in its tracks.

The stone-cold reality is this: the American pharmaceutical sector is propped up by taxpayer-funded research, dominated by foreign-controlled conglomerates, guarded by regulatory capture, and protected by patent monopolies that delay competition and inflate prices.

Billions in public R&D, a Medicare system legally barred from negotiating prices, and international trade deals that underwrite foreign price controls have created a twisted global subsidy regime.

And guess who’s picking up the tab? You are.

Under the current system, American patients—especially seniors and those with chronic illnesses—routinely pay five to ten times more than their counterparts in Europe, Canada, Israel, and even China. A comprehensive RAND Corporation study confirms it: U.S. drug prices are, on average, 2.78 times higher than those in 33 other developed nations.

For brand-name drugs, the disparity is even worse—Americans pay more than triple what patients abroad are charged, even after accounting for rebates and negotiated discounts.

President Trump’s “Most Favored Nation” pricing order simply says: no more. If Germany pays $45 for a drug, we’re not paying $450.

That’s not creeping socialism. It’s the beginning of the end of one of the greatest wealth redistribution schemes in the modern American economy—one that funnels billions from U.S. taxpayers into the coffers of foreign governments and multinational drug firms.

The President’s executive action doesn’t impose price caps in any traditional sense. It simply insists that American taxpayers receive at least the same deal extended to foreign governments.

If that sounds radical, it only proves how far the establishment has drifted from common sense. As the President put it, “[i]n case after case, our citizens pay massively higher prices than other nations pay for the same exact pill, from the same factory, effectively subsidizing socialism [abroad] with skyrocketing prices at home.” Or, as one observer summarized, this “was a wrecking ball to Big Pharma.”

And make no mistake—the pharmaceutical industry will come out swinging, just as it always does when its profit margins are threatened. I’ve been in the trenches of this fight before.

As Commissioner and later as Chairman of the North Carolina Industrial Commission, I helped lead a reform effort to end price-gouging by ambulatory surgical centers and others in our state’s workers’ compensation system. We implemented a fair, Medicare-based fee schedule to replace the old “wild west” model, allowing some providers to charge whatever they pleased.

The data made it clear: without reform, medical costs would skyrocket—and with them, insurance premiums and taxpayer burdens.

The pushback was swift, loud, and coordinated. Lobbyists mobilized. Lawsuits were filed. And that was only the beginning.

But what I remember most vividly wasn’t the public opposition—it was the private pressure.

Political operatives warned me the donor class wouldn’t like it. Some offered vague legalistic objections, while others were more direct: These people write big checks.

The message couldn’t have been clearer: stand firm, and expect headaches, lawfare, and political blowback. Back down, and things get easier—at least for the lobbyists, donors, and political class. But not for the taxpayers and employers left holding the bag.

The people applying the pressure weren’t left-wing activists, mind you. Many were Republicans. Many called themselves conservatives. But when faced with the choice between standing firm or pleasing the funders, they flinched, because money makes their world go round.

I would have none of it. We saw the reform through. And we won. The North Carolina Court of Appeals upheld the Commission’s authority, the state Supreme Court declined review, and the savings were real.

Surgical reimbursements dropped nearly 40%, far exceeding actuarial projections. Premiums stabilized, even decreased substantially. The system became more accountable. And not a single patient was denied necessary care.

I took note. Not everyone who smiles in the strategy room is someone you want in the foxhole when the incoming rounds start. Not everyone who claims to support reform or calls themselves a conservative truly is.

What President Trump is doing today echoes that same battle, only now on a national scale. And once again, the same divide is appearing.

Some critics may be genuinely concerned about government involvement in pricing. I can respect that. But I also have to ask: What’s their solution? Because defending the status quo—a system that bankrupts American families while subsidizing foreign health care—is not a serious answer. It’s surrender dressed up as principle.

But many others are simply defending a rigged system that has made them rich. Consulting contracts, cocktail party invites, corporate board seats, and campaign donations are all part of the racket, and they’re desperate to preserve it.

And here’s the part that would be funny if it weren’t so predictable: the self-styled progressives will oppose this, too.

Despite all their rhetoric about corporate greed, health care justice, and “Big Pharma,” they will reflexively attack this executive order. Why? Because it wasn’t issued by one of their own, and because it doesn’t advance their ultimate goal: total state control.

You can already assume this action will be challenged in court. The “resistance” attorneys in the lawfare cartel have the playbook memorized. We’ve seen it before—and we’ll see it again—not because the policy is flawed but because it came from the wrong President.

And that reveals something more profound. For the progressive movement, reducing drug costs has never been the objective. Control is. Political power is. The moral posturing is just theater. They’ll tolerate any price if the system can be centralized under bureaucratic command, especially if the dollars keep flowing into their campaign coffers.

And it’s no accident that every significant health care “reform” embraced by the left of the last several generations has failed to contain costs. Costs have only spiraled higher and higher with each new piece of legislation. And if you liked your plan before, chances are it no longer exists. If you liked your doctor, you’re lucky if you’re still a patient.

But what if President Trump can bring costs down without expanding the state? That’s heresy to the left and its acolytes. And the denizens of the progressive left will do everything they can to kill it before it takes effect.

They’ll even embrace conservative critiques that call it a violation of market economics, while conveniently ignoring the reality that “market economics” in the pharmaceutical sector is a will-o’-the-wisp, a fantasy of wishcasting writ large.

There’s a reason Bernie Sanders, despite his anti–Big Pharma rhetoric, has quietly accepted hundreds of thousands in campaign cash from the very industry he denounces—just routed through its employees rather than its PACs.

Authentic conservative leadership isn’t about parroting slogans. It’s about standing up to entrenched power—even when it’s inconvenient or comes from “our side” or the donor class. And fundamentally, there is nothing conservative, nor remotely aligned with free-market principles, about letting foreign governments dictate U.S. drug prices while robbing us blind.

There is nothing Austrian School about taxpayer-funded monopolies redistributing American dollars overseas.

And there is nothing principled about forcing American seniors to subsidize state-run health care in Berlin or Brussels.

President Trump is doing what Republicans should have done a generation ago—not by creating yet another government program that gives Democrats part of what they want while saddling Americans with new mandates and edging the nation closer to insolvency.

Instead, he’s putting Americans first—patients, taxpayers, and families.

The swamp may not like it. But the country will.