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Joe Biden’s assault on the $900 child-eczema cream

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BUYING PRESCRIPTION DRUGS in America can feel a bit like being a tourist haggling at a street market. First, a ludicrous “retail price” is mentioned (for your correspondent recently, $902 for eczema cream for a child). Then, insurance is applied, followed by a layering-on of coupons (often printed by the pharmacist and then handed to themselves), discount cards and rebate claims. And yet even after all that, the amount of cash you pay out of pocket is still steep by international standards (the cream ended up costing $273).

Americans agree on few things, but lowering the price they pay for medication is the most popular policy position in American politics, tied with support for Social Security. Nine in ten say this should be an important or top priority for Congress. In his State of the Union address Joe Biden spent a full three minutes on the topic. Yet just over one in four say they are aware of President Biden’s attempts via the Inflation Reduction Act (IRA) of 2022 to reduce prices—something he is trying to rectify ahead of the presidential election in November. At least as interesting as the direct effect of Mr Biden’s landmark law is the question of what the indirect effects might be.

Americans spend twice as much on prescription medication per person as comparable countries, according to Peterson-KFF, a health-research group. This spending is heavily skewed by branded drugs with no competitors, so-called non-generic drugs. These make up 10% of prescription drugs but 80% of spending. Adjusted for inflation, spending on prescription drugs has increased from $101 per person in 1960 to $1,147 in 2021. Unsurprisingly, that scale of increase has an effect on care: nearly one in three Americans say they sometimes skip taking medication as prescribed because of the price tag.

The IRA, which was mainly a climate-change and industrial-policy law, did actually have some provisions designed to bring down inflation (although not in the short term). One politically important one relates to Medicare, the public-health insurer for the elderly which covers prescription drugs for 50m people.

The IRA empowered Medicare administrators to negotiate prices with drugmakers, which they had long been forbidden from doing. This should eventually reduce the price consumers pay, though probably not until a few years after the next presidential election. In the near term, the IRA also capped some out-of-pocket drug costs. The first to feel the effects of these measures are people with diabetes who need insulin, a drug for which Americans pay several times what Europeans pay. A national out-of-pocket cap of $35 per insulin prescription per month has meant that, since January 2023, millions enrolled in Medicare can now get insulin at a reduced price.

Another tangible result is an annual cap on out-of-pocket spending. Doug Hart, a 77-year-old from Arizona with heart disease, previously spent about $7,000 per year on prescription medication. Under the new cap, which is being phased in, he will be on the hook only for the first $3,300 this year,, before Medicare foots the rest of the bill. From next year, the cap will be lowered to $2,000. “The way I see it, Biden is saving me $5,000 in out-of-pocket drug costs [and] I can go and see my grandkids in Chicago instead,” he adds. Both measures have brought substantial relief to people on Medicare, says Juliette Cubanski, at KFF, noting that the average annual income for participants is less than $36,000.

These first measures have been relatively easy to implement because they enjoy bipartisan support and the pharmaceutical industry does not mind them—if anything, it welcomes them, because they make drugs cheaper for consumers while the government picks up the difference. The second half of Mr Biden’s law, which gives Medicare a mandate to negotiate drug prices directly with manufacturers and penalises drug companies that raise prices above inflation, has been met with more hostility from the industry. Yet it is this part that will make a difference for taxpayers (and the deficit): without it, the price caps for consumers will just push high drug bills on to the government.

Negotiations between the government and Big Pharma are under way behind closed doors. Drug companies are keen to reassure shareholders that the government’s proposals are not as outlandish as feared. Yet at the same time they have filed several lawsuits challenging the legislation. One way or another the federal agency that administers Medicare will publish a list of the “maximum fair price” for each of the first ten negotiated drugs by this September, with the intention of introducing these discounts by 2026. The list includes Eliquis, a blood-thinner used by around 3.5m Medicare patients,including Mr Hart and “half the people” he knows. Medicare spending on these ten drugs more than doubled between 2018 and 2022.

Mr Biden’s claim that he has already saved American taxpayers $160bn thanks to these negotiations is misleading, because it relies on projections of future government savings. No doubt the price negotiations, which will ramp up to cover at least 20 drugs per year by 2029, will be good for the public purse. Ozempic, a diabetes and weight-loss drug, is an obvious candidate for the next tranche. The impact could be substantial: gross Medicare spending on such weight-loss drugs for a growing number of conditions has increased from $57m in 2018 to $5.7bn in 2022. Ozempic alone was the sixth most expensive drug for Medicare in 2022.

There is also the question of what the knock-on effects of the IRA will be, both for other drugs and beyond Medicare. “Now that the government has these new tools, there are huge opportunities to go beyond it [the IRA],” says Richard Frank, at the Brookings Institution, a think-tank. Benedic Ippolito, at the AEI, another think-tank, says that the real question is how the law will evolve in the future. “If you can suddenly negotiate more drug prices, earlier in their life cycle, or these prices apply to the entire private market, then suddenly this is not an incremental change—this is a sea change.”

Mr Biden has said he will try both to increase the number of drugs subject to negotiation and expand the $2,000 out-of-pocket cap to people with private insurance. Expanding the negotiations to 500 drugs over ten years would be “transformative”, says Merith Basey, from Patients For Affordable Drugs, an advocacy organisation. And once the prices that Medicare pays for expensive drugs are published, this might increase the bargaining power of private insurers too.

Over eight in ten Americans support the idea that the federal government should be able to directly negotiate with Big Pharma on drug prices and nine in ten believe price increases should not outpace inflation. “Any elected official who aligns themselves with pharma and against the will of voters will do so at their own political risk,” warns Ms Basey. The president’s campaign team will be hoping that enough people notice the new, reduced Medicare drug prices, which will be announced in September—just in time for the election.

Another scenario is just as likely: Mr Trump wins and claims credit for Mr Biden’s achievement, because the price reductions would not actually come into force until 2026. That would be the Trumpiest move. Either way, patients should benefit.

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How did the U.S. arrive at its tariff figures?

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U.S. President Donald Trump speaks during a “Make America Wealthy Again” trade announcement event in the Rose Garden at the White House on April 2, 2025 in Washington, DC.

Chip Somodevilla | Getty Images

Markets have turned their sights on how U.S. President Donald Trump’s administration arrived at the figures behind the sweeping tariffs on U.S. imports declared Wednesday, which sent global financial markets tumbling and sparked concerns worldwide.

Trump and the White House shared a series of charts on social media detailing the tariff rates they say other countries impose on the U.S. Those purported rates include the countries’ “Currency Manipulation and Trade Barriers.”

An adjacent column shows the new U.S. tariff rates on each country, as well as the European Union.

Chart of reciprocal tariffs.

Courtesy: Donald Trump via Truth Social

Those rates are, in most cases, roughly half of what the Trump administration claims each country has “charged” the U.S. CNBC could not independently verify the U.S. administration’s data on these duties.

It didn’t take long for market observers to try and reverse engineer the formula — to confusing results. Many, including journalist and author James Surowiecki, said the U.S. appeared to have divided the trade deficit by imports from a given country to arrive at tariff rates for individual countries.

Such methodology doesn’t necessarily align with the conventional approach to calculate tariffs and would imply the U.S. would have only looked at the trade deficit in goods and ignored trade in services.

For instance, the U.S. claims that China charges a tariff of 67%. The U.S. ran a deficit of $295.4 billion with China in 2024, while imported goods were worth $438.9 billion, according to official data. When you divide $295.4 billion by $438.9 billion, the result is 67%! The same math checks out for Vietnam.

“The formula is about trade imbalances with the U.S. rather than reciprocal tariffs in the sense of tariff level or non-tariff level distortions. This makes it very difficult for Asian, particularly the poorer Asian countries, to meet US demand to reduce tariffs in the short-term as the benchmark is buying more American goods than they export to the U.S., ” according to Trinh Nguyen, senior economist of emerging Asia at Natixis.

“Given that U.S. goods are much more expensive, and the purchasing power is lower for countries targeted with the highest levels of tariffs, such option is not optimal. Vietnam, for example, stands out in having the 4th largest trade surplus with the U.S., and has already lowered tariffs versus the U.S. ahead of tariff announcement without any reprieve,” Nguyen said.

The U.S. also appeared to have applied a 10% levy for regions where it is running a trade surplus.

"Absolutely nothing good coming out" of Trump tariff announcement, veteran economist Rosenberg says

The Office of the U.S. Trade Representative laid out its approach on its website, which appeared somewhat similar to what cyber sleuths had already figured out, barring a few differences.

The U.S.T.R. also included estimates for the elasticity of imports to import prices—in other words, how sensitive demand for foreign goods is to prices—and the passthrough of higher tariffs into higher prices of imported goods.

“While individually computing the trade deficit effects of tens of thousands of tariff, regulatory, tax and other policies in each country is complex, if not impossible, their combined effects can be proxied by computing the tariff level consistent with driving bilateral trade deficits to zero. If trade deficits are persistent because of tariff and non-tariff policies and fundamentals, then the tariff rate consistent with offsetting these policies and fundamentals is reciprocal and fair,” the website reads.

This screenshot of the U.S.T.R. webpage shows the methodology and formula that was used in greater detail:

A screenshot from the website of the Office of the United States Trade Representative.

Some analysts acknowledged that the U.S. government’s methodology could give it more wiggle room to reach an agreement.

“All I can say is that the opaqueness surrounding the tariff numbers may add some flexibility in making deals, but it could come at a cost to US credibility,” according to Rob Subbaraman, head of global macro research at Nomura.

 — CNBC’s Kevin Breuninger contributed to this piece.

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Analysts react to latest U.S. levies

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Charts that show the “reciprocal tariffs” the U.S. is charging other countries are on display at the James Brady Press Briefing Room of the White House on April 2, 2025 in Washington, DC. 

Alex Wong | Getty Images

U.S. President Donald Trump on Wednesday laid out the “reciprocal tariff” rates that more than 180 countries and territories will face under his sweeping new trade policy.

The announcement sent stocks tumbling and prompted investors to seek refuge in assets perceived to be safe.

Analysts generally had a pessimistic take on the announcement, with some even predicting an increased risk of a recession for the U.S.

Here is a compilation of reactions from experts and analysts:

Tai Hui, APAC Chief Market Strategist, J.P. Morgan Asset Management

“Today’s announcement could potentially raise U.S. average tariff rates to levels not seen since the early 20th century. If these tariffs persist, they could materially impact inflation, as U.S. manufacturing struggles to ramp up capacity and supply chains pass on costs to consumers. For instance, advanced semiconductor manufacturers in Taiwan may not absorb tariff costs without viable substitutes.

“The scale of these tariffs raises concerns about growth risks. U.S. consumers may cut back on spending due to pricier imports, and businesses might delay capital expenditures amid uncertainty about the tariffs’ full impact and potential retaliation from trade partners.”

David Rosenberg, President and founder of Rosenberg Research

“There are no winners in a global trade war. And when people have to realize, when you hear this clap trap about how consumers in United States are not going to bear any brunt. It’s all going to be the foreign producer. I roll my eyes whenever I hear that, because it shows a zero understanding of how trade works, because it is the importing business that pays the tariff, not the exporting country.

And a lot of that will get transmitted into the consumer, so we’re in for several months of a very significant price shock for the American household sector.”

Anthony Raza, Head of Multi-Asset Strategy, UOB Asset Management

“They’ve come up with the most extreme numbers that we can’t even comprehend. How they’re coming up with these? And then in terms of timing, I think we were hopeful that maybe this would be something that was rolled out over the course of a year, that would allow like time for negotiations or whatever. But it does seem like the timing is much more immediate and is, again, worse than our worst-case type scenario in terms of flexibility.”

David Roche, Strategist, Quantum Strategy

“These tariffs are not transitional. They are core to President Trump’s beliefs. They mark the shift from globalisation to isolationist, nationalist policies – and not just for economics. The process will last several years and be felt for decades. There will be spillovers into multiple policy domains such as geopolitics.

Right now, expect retaliation, not negotiation by the EU (targeting U.S. services) and China (focusing on U.S. strategic and business interests). The Rose Garden tariffs will cement the bear market. They will cause global stagflation as well as U.S. and EU recession.”

Shane Oliver, Head of Investment Strategy and Chief Economist, AMP

“Our rough calculation is that the 2nd April announcement will take the US average tariff rate to above levels seen in the 1930s after the Smoot/Hawley tariffs which will in turn add to the risk of a US recession – via a further blow to confidence and supply chain disruptions – and a bigger hit to global growth.

“The risk of a US recession is probably now around 40% and global growth could be pushed towards 2% (from around 3% currently) depending on how significant retaliation is and how countries like China respond with policy stimulus.”

Tom Kenny, Senior International Economist, ANZ

“Today’s announced US reciprocal tariffs are worse than expected. The effective tariff rate on U.S. merchandise imports is likely to climb to the 20-25% range, the highest since the early 1900s.

Yields on inflation-indexed bonds were higher and equities sold off after the announcement, suggesting the market thinks these tariffs will hurt growth and add to inflation. Market pricing of the federal funds rate points to cuts from the Federal Reserve coming sooner.”

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EC President von der Leyen

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The European Union is preparing further countermeasures against U.S. tariffs if negotiations fail, according to European Commission president Ursula von der Leyen.

U.S. President Donald Trump had imposed 20% tariffs on the bloc on Wednesday.

Von der Leyen’s comments come after retaliatory duties were announced by the bloc after the U.S. imposed tariffs on  last month in a bid to protect European workers and consumers. The EU at the time said it would introduce counter-tariffs on 26 billion euros ($28 billion) worth of U.S. goods.

Previously suspended duties — which were at least partially in place during Trump’s first term as president — are set to be re-introduced alongside a slew of additional duties on further goods.

Industrial-grade steel and aluminum, other steel and aluminum semi-finished and finished products, along with their derivative commercial products, such as machinery parts and knitting needles were set to be included. A range of other products such as bourbon, agricultural products, leather goods, home appliances and more were also on the EU’s list.

Following a postponement, these tariffs are expected to come into effect around the middle of April.

This is a developing story, please check back for updates.

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