Thanksgiving, Post-Election: Four Policy Issues from a Public Health Economist

I have been thinking a lot about the election, but the lack of specifics in Donald Trump’s plan makes it hard to say much about what is likely to happen in pharma or biomedical research policy.

I’m not sure I have much to say that would be relevant at Thanksgiving, but here are some wonky thoughts:

There has been tough talk during the campaign about drug prices, including Medicare negotiation and potential re-importation of drugs from Canada. The question here is whether Mr. Trump will implement a standard Republican agenda towards pharma (which would mean abandoning these campaign statements), or if his “outsider” status lets him try new things that previous Republicans (and for that matter Democrats) were unable or unwilling to do. The markets have spoken: drug stocks seem to be doing well. The industry seems to believe that Trump will be easier on drug prices than Clinton would have been. But my sense is there is a lot of uncertainty, including on the impact of potential changes in insurance on demand for drugs, and about the general economic climate. 

One specific thing Trump has proposed is faster approvals through the FDA. The perennial questions about this are (a) who pays for this? (b) if not well-funded, will this result in cutting corners and more unsafe drugs on the market? We’ll have to wait and see these will be answered.

Though Trump said some not nice things about the NIH during the campaign (mainly in offhand comments on a radio show, scaring scientists everywhere), one of his main advisors, Newt Gingrich, has called for a doubling of the NIH budget as recently as last year. Unless there is general economic decline, NIH budget trends typically don’t change much administration-to-administration. The NIH has historically been above the fray and has had bipartisan support unparalleled by most federal agencies. To be sure, Republicans are less friendly towards certain types of research (including public health research) than Democrats, but I’d expect any changes in allocation to be incremental not radical. But, as with much of this, it is really hard to predict given the lack of any policy specifics from the new administration and real uncertainty about how he will interact with Congress. 

Finally, the U.S. scientific workforce is heavily reliant on immigrants, and has always been. More generally, science and technology are increasingly global efforts. Anti-immigrant and isolationist rhetoric and policy could have several negative effects on the U.S. scientific and technological enterprise. It could be especially detrimental if Mr. Trump follows through on some of his most divisive rhetoric. 

by Bhaven Sampat, PhD, Associate Professor in the Department of Health Policy and Management