In 2016, Donald Trump promised to repeal the ACA and lower drug prices. In 2020, he claimed a plan was “two weeks away.” Now, more than 100 days back in office and facing mounting pressure to act on policy ahead of the 2026 midterms, Trump is once again pledging to fix American healthcare. Will this time be different?
Here are three tests that Americans can use to gauge whether the Trump administration succeeds or fails in delivering on its healthcare agenda.
Test No. 1: Have drug prices come down?
Americans pay two to four times more for prescription drugs than citizens in other wealthy nations. Today, nearly 30% of U.S. prescriptions go unfilled due to cost, leaving millions without the medications they need.
President Trump has repeatedly promised to change that. He recently stated, “The United States will no longer subsidize the healthcare of foreign countries and will no longer tolerate profiteering and price gouging.”
To support these commitments, the president signed an executive order titled “Delivering Most-Favored-Nation (MFN) Prescription Drug Pricing to American Patients.”
The order directs HHS to develop and communicate MFN price targets to pharmaceutical manufacturers, with the hope that they will voluntarily align U.S. drug prices with those in other developed nations. The idea is simple: If Germany and Canada pay $100 for a medication, Americans shouldn’t be charged $500. Should manufacturers fail to make significant progress toward these new targets, the administration has threatened to pursue additional measures, including the importation of drugs and tariffs.
Mandated price reductions would require congressional legislation—not just executive orders. The pharmaceutical industry is aware of this and is already pushing back, arguing that pricing reforms will hinder innovation and slow the development of lifesaving drugs.
But here’s the truth about drug “innovation”: According to a study by America’s Health Insurance Plans, seven out of 10 of the largest pharmaceutical companies spend more on sales and marketing than on research and development. If pharmaceutical companies want to invest more in R&D, a great start would be for them to require all nations to pay their fair share for identical medications.
If Congress fails to act on pharma pricing, the FDA could redefine “drug shortages” to include medications priced beyond the reach of most Americans. That change would enable compounding pharmacies to produce lower-cost alternatives just as they did recently with GLP-1 weight-loss injections.
However, if Americans continue paying more than twice as much as citizens in other wealthy nations, the administration will have failed this crucial test.
Test No. 2: Did food health quality improve?
Obesity has become a leading health threat in the United States, surpassing smoking and opioid addiction as a cause of death.
Since the 1980s, adult obesity rates have surged from 15% to over 40%, contributing significantly to chronic diseases, including type 2 diabetes, heart disease, and multiple types of cancers.
A major driver of this epidemic is the widespread consumption of ultra-processed foods: products high in added sugar, unhealthy fats, and artificial additives. These foods are engineered to be hyper-palatable and calorie-dense, promoting overconsumption and, in some cases, addictive eating behaviors.
In May, Health and Human Services Secretary Robert F. Kennedy Jr. led the release of the White House’s Make America Healthy Again (MAHA) report, which identifies ultra-processed foods, chemical exposures, lack of exercise, and excessive prescription drug use as primary contributors to America’s chronic disease epidemic. But success here will be measured by action, not rhetoric.
Thus, the administration will need to implement tangible policies such as:
· Front-of-package labeling. Require clear and aggressive labeling to inform consumers about the nutritional content of food products, using symbols to distinguish between healthy and unhealthy options.
· Taxation and subsidization. Impose taxes on unhealthy food items and use the revenue to subsidize healthier food options, especially for socio-economically disadvantaged populations.
· Regulation of food composition. Restrict the use of harmful additives and limit the total amount of fat and sugar included, particularly for foods aimed at kids.
Some of these policies have already been adopted in other nations and even in some U.S. states, showing they are achievable with political will. But if nothing changes, obesity will continue to rise, and the administration will fail.
Test No. 3: Are patients using generative AI to improve health?
The White House has signaled a strong commitment to using generative AI across various industries, including healthcare. Food and Drug Administration Commissioner Dr. Marty Makary has announced plans to integrate generative AI across all FDA centers by the end of this month.
But internal efficiency alone won’t improve the nation’s health. The administration will need to help develop and approve GenAI tools that expand clinical access, improve outcomes, and reduce costs. Ultimately, the real test will be whether the administration can turn GenAI into a tool for patients, not just paperwork.
Generative AI holds enormous promise. It can help patients better manage chronic diseases through continuous monitoring and by generating alerts when medication adjustments are needed. It can save lives by reducing the 400,000 annual deaths from misdiagnoses. It can also improve outcomes by personalizing treatment recommendations.
But realizing this potential will require major shifts. The NIH will need to fund the development of GenAI tools designed specifically for patient use, not just administrative tasks. The FDA will need to modernize outdated regulations that were built for static software, not constantly learning technologies. Most importantly, regulatory agencies must abandon the illusion of zero risk and evaluate new tools based on real-world performance, rather than theoretical perfection.
Ultimately, if generative AI technology remains confined to billing support and back-office automation, the opportunity to transform American healthcare will be lost. And the administration will have missed a vital opportunity to lower costs, save lives and ease clinician burnout.
Robert Pearl, the author of “ ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.