☕️ Croaky’s Conservative Coffeehouse
Substack title might be the same: No, We Don’t Need Socialist Drug Pricing—We Need a Real Conservative Cure
Now, before we proceed, let me confess something that those closest to me already know and quietly mock: I despise talking about medical policy. Not because I don’t care, but because it usually requires parsing the sacred scrolls of FDA jargon, insurance bureaucracy, and pharmaceutical labyrinths—none of which pairs well with espresso or sanity.
So, yes—this post is me spitballing, or as the credentialed class might call it, engaging in preliminary exploration of policy frameworks absent formal peer-reviewed vetting. (I call it having thoughts.) I’ll consult with my far more medically literate wife—who will no doubt correct me with that precise mixture of grace and raised eyebrow—and return with a full Substack article when I’m less caffeinated and more informed.
But for now, let’s do what conservatives used to do before surrendering their spines to populist strongmen and their brains to bumper-sticker economics:
think.
Here are some good old-fashioned conservative ideas—before we give up yet another domain of free-market credibility in favor of bureaucratic price-fixing, state-directed purchasing, or whatever “Marxist-lite” pill populism is peddling this week as a “win.”
Let me know what you think as I sharpen this into a fuller piece—and if you enjoy it, buy me a coffee and become a supporter. Because if we want conservative analysis to grow rather than fade into the soft dim light of AM radio grievance rants, we’re going to need a little caffeine and a lot of clarity.
Trump Price Fixing
You’ve probably heard the latest from the Trump camp: a new executive order to lower drug prices by tying them to the lowest prices in foreign nations (a.k.a. “Most-Favored-Nation” pricing or MFN). The idea? If Canada pays less, why should we pay more?
Sounds good if you’re skimming headlines. But if you’re me—and presumably you are, spiritually—you stop mid-sip and ask:
Wait… since when did conservatives outsource policy to European socialists?
Let’s not pretend this is a market solution. It’s a government-mandated price cap imported from countries with centralized healthcare—and wrapped in red, white, and blue ribbon like that makes it conservative. Spoiler: it doesn’t.
But here’s the good news: there are actual conservative solutions. And unlike executive orders scribbled in crayon and launched during a bad news cycle, these ideas respect markets, reduce costs, and preserve the innovation that keeps us alive.
🧪 1. Reform the Real Problem: PBMs
PBMs (Pharmacy Benefit Managers) are middlemen who jack up prices, pocket secret rebates, and pretend they’re saving you money. Want to fix pricing?
Ban spread pricing. Force transparency. Make PBMs act as fiduciaries.
⚖️ 2. Deregulate the FDA, Not Prices
Competition drives down costs. Bureaucracy keeps prices high.
Fast-track generics. Approve biosimilars faster. Accept drugs approved by allies like the UK or EU. Let Americans buy what works—without waiting for 8 layers of FDA delay.
💵 3. Empower the Cash Market
You want lower prices? Let people see them.
Support programs like-groan-Mark Cuban’s Cost Plus Drugs. Allow Health Savings Accounts (HSAs) to be used freely for prescriptions.
More cash transparency = more accountability = lower costs.
🗳️ 4. Embrace Federalism
This one as most of you who know me is my overall solution for a lot of things. Let Florida, Texas, and Vermont experiment. Some states are negotiating better deals or exploring importation. Good.
Let states compete. Let success scale. Washington shouldn’t be micromanaging your medicine cabinet they can't even manage the budget.
📜 5. Defend Patents, Not Monopolies
We believe in property rights, not infinite rent-seeking.
End “evergreening” tricks that extend patents with no therapeutic benefit. Encourage competition. Don’t protect zombie monopolies.
✂️ 6. Cut the Bureaucratic Fat
Reform prior authorization, simplify formularies, and get price comparison tools into patients’ hands.
The current system makes confusion profitable. Let's make clarity king.
❌ And what should we NOT do?
Don't copy socialist Europe while waving an American flag.
Don’t declare war on innovation with price caps disguised as populism.
Don’t hand the regulatory state a sledgehammer and call it a scalpel.
Real conservatism isn’t loud. It’s lasting.
It doesn’t scream “I alone can fix it.” It fixes the system, so people don’t need fixing later.
So next time someone says “Why don’t we just pay what France pays?”, kindly ask them:
Do you want their rationing too? Their delays? Their innovation vacuum?
Because in this Coffeehouse, we drink our brew strong, black, and free—like our markets should be.
Croaky Caiman, Defender of Ordered Liberty, Slayer of Bad Policy, First of His Name in Health Policy Threads
☕️ If you enjoyed this add your own ideas and consider buying me a coffee to help keep the analysis coming—unfiltered, unapologetic, and uncorrupted by pharma lobbyists.