Trump gave up bargaining chips on prescription drug prices, got nothing for them Donald Trump gave away big bargaining chips on prescription drug prices in exchange for nothing. This remains the worst health care presidency in modern times.

Andy Slavitt | Opinion columnist

Reducing prescription drug costs were President Trump’s best chance for a health care victory in what so far has been the worst health care presidency in modern times. Americans are feeling significant pain on this issue. As many as one in four report difficulty affording their medications. Too often we hear stories about unexplainable price jumps for common medications that people depend on to stay alive, like insulin and EpiPen.

There were high expectations for Trump after a campaign in which he accused drug companies of “getting away with murder” with their unchecked prices, and vowed to take them on. Americans are unified in how they want their government to respond; 92% say it should use its negotiating power to reduce drug prices for Medicare. Sensing a populist wave, in one of his most important and surprising campaign pledges, then-candidate Trump said he would "negotiate like crazy." He even promised that his negotiating skills would save taxpayers $300 billion annually.

So far Trump hasn’t made a dent. Since he became president, the prices of over 2,500 drugs already on the market have increased by at least double digits. That was all supposed the change with Trump’s big speech Friday. But even as he vowed to press on to “total victory,” there was no trace of even a fraction of $300 billion in savings, or any immediate relief for consumers.

More: Drug companies get tax windfall, but they're not reducing prescription prices

More: Narcan saved me from an opioid overdose. Trump should make it cheaper.

Instead, Trump’s speech and accompanying “American Patients First” blueprint turned out to be a huge relief for drug companies. There were no calls for negotiation (there was even a recommended boost for drug companies to get higher overseas prices) or drug re-importation — the two campaign promises that would have had the biggest impact on consumers.

Naturally, drug company stocks rallied after the speech. One Wall Street analyst, Ronny Gal of Sanford C. Bernstein, summarized drug company reaction this way. “Obviously, very, very positive to pharma. Essentially, we are not seeing anything in the speech which should concern investors.”

So, what was the speech all about?

Trump was silent on drug prices through the first 16 months of his presidency. Yet, politically, drug prices are quickly becoming the new gas prices. With the November elections approaching, Trump needed to say something.

But through many administrations, drug companies have fought any effort at price negotiation with the not-so-veiled threat that any cures for cancer and Alzheimer’s and other innovations are entirely dependent on the money they make as a result of higher prices — that is, the government not using its full negotiating authority.

This argument sidesteps the question of the thousands of drug prices each year that rise significantly long after a drug has been on the market. Americans expect other industries to bring down prices over time, as they have more customers and improve operations, and still invest in innovation. There is no reason to assume that drug companies can’t do the same.

The administration now says the government wouldn’t be able to reduce prices because it can’t effectively negotiate with the pharmaceutical industry. Tell that to the Veterans’ Administration; its prices would make a fine place to start negotiations.

Here’s the truth: The decision not to negotiate protects profits and hurts consumers.

There were some encouraging proposals in the details released by Trump’s Department of Health and Human Services that, if implemented, could work over the longer term. They include suggesting that list prices be disclosed in TV ads, encouraging biosimilars (generic drugs for expensive cancer and other therapies), and proposing changes to how drugs administered by physicians are paid for. Those are all good ideas — but they will take years to have an impact, presuming they can prevail over what will be strong opposition.

The biggest miss in Trump’s plan is not that the ideas in it are bad, but that the focus is on longer term changes while ignoring the immediate crises Americans face. For example, Trump criticizes other nations for controlling the cost of prescription drugs to their citizens. Yet rather than conclude that the U.S. ought to do the same, he suggests that other countries raise their prices in the hope that drug companies will then lower their prices in the U.S. Spoiler alert: they won’t.

More: I still want to work with GOP to fix health care and lower costs: Patty Murray

POLICING THE USA: A look at race, justice, media

U.S. taxpayers fund much of the basic research for drug discovery and still pay the highest prices. A proposal more in keeping with his vow to put “American Patients First” would have allowed American consumers to re-import drugs at prices paid by Canadians until drug companies bring down U.S. prices to match what Canadians pay.

Trump has also made another key mistake. As a negotiator, he just gave away the two biggest issues on the table — negotiation and re-importation — without getting anything in return. This allows drug companies to focus all their lobbying firepower on his more modest proposals, which puts even those in jeopardy.

While he missed his chance for boldness, don’t expect Trump’s rhetoric to change.

"We will have tougher negotiation, more competition, and much lower prices at the pharmacy counter. And it will start to take effect very soon," the president said last week in his big reveal. When that doesn’t happen, will his supporters hold him accountable? They should.

Andy Slavitt, board chairman of United States of Care and a partner in Town Hall Ventures, ran Medicare, Medicaid and the Affordable Care Act during the Obama administration. Follow him on Twitter: @aslavitt