Last week he launched TrumpRx.com. If you were to ask me to trade his accomplishments – many like revitalizing the Monroe Doctrine or being instrumental in overturning Roe Vs. Wade that I had only previously dreamed of – for less boorish and at times offensive behavior, I’d take the accomplishments every single time.
Whether you love President Donald Trump or loathe him, everyone can agree that he has survived statements and events, often self-inflicted, that would have ended the career of almost any other politician in modern memory. At this point, the instances are almost too numerous to count, having begun on day one of his presidential announcement when he claimed that foreign countries aren’t sending us their best and culminating on day 3,889 following a racist trope embedded in a social media post last week. In many ways, the similarities between the two illustrate the old adage about how the more things change, the more they stay the same. When then-candidate Trump declared on June 19, 2015, he said “They’re sending us not the right people…The US has become a dumping ground for everyone else’s problems. They’re sending people that have lots of problems and they’re bringing their problems. They’re bringing drugs, they’re bringing crime, they’re rapists, and some I assume are good people but I speak to border guards and they tell us what we are getting,” much of the mainstream media promptly declared him a racist with no chance of winning, believing he’d detonated his campaign on the launch pad. Though few seriously believe a sitting President can be so easily removed from the office over a tweet, the same charges accompanied last week’s social media post on Truth Social. In fact, CNN placed it as “merely the latest in a long line of Trump’s ugly social media posts.” After recounting the incident Aaron Bloke noted, “the biggest point might be that we’ve been here before — a lot. Trump’s social media feed over the years has at times resembled what you might expect from an alt-right provocateur. CNN reports that Trump often posts personally on Truth Social, including reposts of others’ posts, although a couple close aides also have access. But to the extent anybody around him is interested in avoiding episodes like this, there’s been remarkably little quality control. In fact, it was a little over a decade ago that Trump’s campaign offered basically a carbon copy explanation for a poorly considered tweet.” Among the not-so-greatest hits, a 2015 tweet where he suggested Iowans were dumb for supporting Ben Carson, a reference in 2016 to Secretary of State Hillary Clinton being funded by Israel with the image of a six-sided star supposedly used by white nationalists, anti-Muslim posts in 2017, British anti-immigration posts in 2019, telling non-white members of Congress that they should “go back and help fix the totally broken and crime infested places from which they came,” Photoshopped images of Democrat leaders in Middle Eastern garb, a video where some supporters appear to be saying “white power,” a video suggesting black and brown people might go after somebody’s daughter if they didn’t vote for Trump, and another Photoshopped video of Democrat leaders, this time in Mexican garb.
While no one can say for sure how, President Trump has managed to defy what many would consider the ironclad laws of politics, prevailing through all these statements, plus many more and of course, two impeachments, almost a hundred indictments and almost forty convictions, the other major event last week that not surprisingly received a lot less coverage provides what I would consider a possible explanation. Shortly before the offensive tweet in question, President Trump announced the official launch of a new website, www.TrumpRx.com to serve as the public face of two major initiatives to lower drug prices in the United States. These include Most Favored Nation Status that ensures competitive pricing with other countries, meaning that pharmaceutical companies cannot sell their products in the United States at prices higher than they do around the world, and direct sales to consumers that bypass Pharmacy Benefit Managers, an obscure group of middlemen many believe greatly increase the overall prices for their own enrichment. Though the media generally downplayed the announcement with CNN claiming it’s unlikely every American’s drug prices will be reduced instantly as if that were the applicable standard and Bloomberg worrying about the impact on drug prices in other countries, few outlets mentioned that none other than Senator Bernie Sanders has been an advocate of Most Favored Nation Status for what many would say are obvious reasons considering we frequently pay several times more (2.78 times on average) and are essentially subsidizing the world’s drug needs. In 2018, Politico reported that “Sen. Bernie Sanders and Donald Trump are on the same page on drug pricing once again. A bill released Tuesday morning by Sanders (I-Vt.) and Rep. Ro Khanna (D-Calif.) to reduce U.S. drug prices takes a cue from the president’s recent proposal to reduce Medicare drug costs — both proposals seek to lower U.S. drug costs by tying them to international prices. It’s the latest alignment on drug prices by populist politicians on opposite sides of the aisle. During their 2016 presidential campaigns, both Sanders and Trump advocated for negotiating the cost of drugs in Medicare and importing cheaper drugs from overseas. Now, they’re embracing the idea of indexing U.S. prices to the lower prices paid by other countries — in effect, relying on price controls set by other countries.” “The president has given this window, and I think it is really important to do this in the lame-duck [session] — to say, ‘If the president is serious about this, he can endorse the proposal,’” Representative Khanna said at the time. “It definitely invites Donald to put his policy where his mouth is,” explained Alex Lawson, executive director of Social Security Works, a left-leaning group that works to protect Social Security. “I think the fact that everyone is discussing this — and you can’t escape it — suggests there will be action,” explained Zeke Emanuel, a former Obama administration health adviser and brother to former Obama Chief of Staff, Rahm Emanuel.
While there was no action then, nor any action while President Joe Biden was in office for four years (to be sure, he did institute a portion of the Medicare negotiations on a handful of drugs, phased in over time) even as he had a Democrat majority which might have achieved this and more, there is action now. Reducing the shadowy role of Pharmacy Benefit Managers in drug prices tells a similar story. Though many have never heard of Pharmacy Benefit Managers in the first place, they are powerful third party administrators who are critical to setting prescription drug benefits for both private insurers and the government. They create lists of which drugs are covered, determine cost sharing tiers, negotiate rebates, adjudicate claims, and create networks of pharmacies. While these are beneficial services in principle, Pharmacy Benefit Managers make most of their money via what is known as “spread pricing,” that is they receive a percentage of the difference between what they charge a health plan and what the pharmacy pays, and via rebates on high priced drugs, meaning that they have a vested interest in keeping the spread and overall prices high. Because only three of these Pharmacy Benefit Managers control about 80% of the entire market, it is widely believed “health insurers and their PBMs are shifting costs to patients through coinsurance and deductibles, choosing profits over patients,” to quote phrma.org, which represents Pharmaceutical Research and Manufacturers of America, “It’s unfair to patients. There have been Congressional inquiries along with an ongoing investigation from the Federal Trade Commission into the PBM industry’s questionable practices.”
In 2023, NPR reported on how “House and Senate members from both parties have launched at least nine bills, parts of which may be packaged together this fall, that take aim at pharmacy benefit managers, companies that channel prescription drugs to patients.” As they saw it, “Other sectors of health care are alarmed by the power of the PBMs and are appealing to the Biden administration and Congress to rein them in. Drugmakers are especially up in arms (more on that later), but employers, pharmacies, doctors, and even patients chafe at PBM practices like ‘spread pricing,’ in which the companies pocket money negotiated on behalf of health plans…Members from both parties talk indignantly about PBM behavior and have fired up bills to address it. The Senate Finance Committee, whose jurisdiction over Medicare and Medicaid gives it a lead role, has introduced a bill that would prohibit PBMs from collecting rebates and fees calculated as a percentage of a drug’s list price, to discourage PBMs from favoring expensive drugs. The committee also plans legislation to require PBMs to pass along discounts directly to seniors, allow patients to use the pharmacy they prefer, and release more information about where their money ends up. Sen. Bernie Sanders, who leads the Senate Health, Education, Labor and Pensions Committee, introduced a bill that bans spread pricing, while measures in the Senate and House would crack down on PBM practices seen as harming independent and rural pharmacies. Other measures require more transparency or limit patient waits for drug approvals.” Though no one would suggest www.TrumpRx.com represents a comprehensive solution, much less the perfect policy, it’s a substantive step towards the sort of reform politicians in both parties have been clamoring for for at least a decade, but were unable to make happen.
Nor is the only supposedly intractable issue the President has taken head on, practically bull in a China shop fashion. Almost every President since Bill Clinton has proposed some form of government funded savings account, variously USA Accounts and Lifetime Savings Accounts, but only President Trump actually delivered with Trump Accounts funded with $1,000 for every child born in the country as part of the Big Beautiful Bill. They have also promised a secure border and improved immigration enforcement inside the country, but only Trump has produced the lowest level of border crossings over a full year since 1970 despite massive and at times, hyperbolic opposition. Likewise, every President since Clinton has promised to move the US embassy in Israel to Jerusalem, but only President Trump actually did so during his first term. Starting with President George W. Bush every occupant of the Oval Office has decried the authoritarian regime in Venezuela – with Bush himself actually supporting a brief coup and President Biden promises consequences if there weren’t free and fair elections – but once again, President Trump is the only one that has actually done something about it, removing President Nicolas Maduro in one of the most daring raids in modern memory and bringing him back to the United States for justice. Similarly. President Bush identified Iran as part of what he called an “Axis of Evil” including Iraq and North Korea, President Barack Obama attempted to negotiate a settlement over their nuclear weapons which resulted in the theocratic regime being flush with cash, leading directly to Hamas’ attack on Israel, and President Biden achieved next to nothing. It was only President Trump who tackled the issue directly, authorized a targeted strike on their nuclear program, setting it back permanently at best, for an extended period at worst. Simultaneously, Presidents since Bill Clinton, if not earlier, have sought improved relations with Middle Eastern countries, hoping to normalize their relationships with Israel, setting the stage for the potential for lasting peace in the region. At the risk of repeating myself, only President Trump delivered, securing the Abraham Accords and improving relations so dramatically that the phrase “Arab Street” now refers to our allies, countries that are working closely with us rather than those that reflexively opposed almost everything we did in the region.
If you are conservative, many of President Trump’s achievements are even more astounding, the sort of thing you would have declared absolutely impossible in 2015 and if someone told you that barely ten years later, even a fraction would have actually happened, you would have insisted they were crazy. For decades, the government has only grown in size and scope (save for a brief period known as sequester under President Obama), thwarting even President Ronald Reagan’s attempts to tame it. When President Trump took office, the regulatory state was set to explode beyond anything previous with massive new regulations affecting prior-to unregulated activities and substances – inland, temporary water ways, carbon dioxide, and the internet itself. Not only did he roll all of that back, but he proceeded to reduce regulations in general in an unprecedented manner and then double down in his second term, cutting the federal payroll by some 300,000 employees and putting plans in place to shutter departments like Education that have vexed Republicans, also since Ronald Reagan. In between, the Supreme Court, revitalized by President Trump’s three picks, two of which were highly unlikely to have succeeded under another Republican President, further upended the administrative state by overturning the Chevron decision, which essentially gave regulators carte blanche to choose what they wanted to regulate and how they wanted it regulated, even if the regulations went far beyond anything considered in the initial legislation, yet another accomplishment that would have made President Reagan proud. Of course, that same Supreme Court also overturned Roe v. Wade, ultimately winning a battle that dates back to before I was born. On the national security and international policy front, a battle had also been brewing over the centuries old Monroe Doctrine leading to Secretary of State John Kerry declaring it dead during President Obama’s time in office, allowing Russia, China, and Iran to operate in our hemisphere with relative impunity until President Trump revitalized the endeavor and promptly applied to Venezuela, Panama (where China has recently been ejected from control of their ports), and Greenland. Lastly, I would be remiss not to mention energy independence. It was George W. Bush who signed the “Energy Independence and Security Act of 2007.” It was, however, President Trump who actually achieved it. As a bonus, the history of tariffs hasn’t fully been written yet, but yet again, we see President Trump tackling challenges that date back to at least to the early 1980s when Bob Dylan released “Union Sundown.”
While I understand that progressives wouldn’t consider many of these accomplishments, to conservatives they most certainly are or should be, and to me at least, they so far outweigh the importance of any social media post or public statement as to make them irrelevant. Putting this another way, if you were to ask me to trade these accomplishments – many like revitalizing the Monroe Doctrine or being instrumental in overturning Roe Vs. Wade that I had only previously dreamed of – for less boorish and at times offensive behavior, going along to get along as we can expect a President Mitt Romney to have done, I’d take the accomplishments every single time. I’m reminded of the great sequence from The Big Lebowski, when the Dude gets arrested after attempting to question Jackie Treehorn and the Malibu Police Chief tells him, “Mr. Treehorn draws a lot of water in this town. You don’t draw shit, Lebowski.” President Trump draws a lot of water; his detractors not so much. You can call me whatever you wish – a deranged cultist, a bootlicker, a sycophant, a racist, a white nationalist, whatever – but in my humble opinion, the President is simply on another level politically and therefore, I give him a very long leash.
Confessions of a Conservative Atheist 