President Trump vowed to overhaul the health care system, notably saying in one of his first post-election speeches that pharmaceutical companies were "getting away with murder" over their pricing tactics.

Yes, but: Four years later, not a lot has changed. If anything, the health care industry has become more financially and politically powerful, Axios' Bob Herman reports.

"Most of the bigger ideas have either been stopped in the courts or just never got implemented," said Cynthia Cox, a vice president at the Kaiser Family Foundation who follows the health care industry.

• The administration killed its own regulation that would have changed behind-the-scenes negotiations between drug companies and pharmacy benefit managers.
• One of the most consequential drug proposals — tying Medicare drug prices to lower prices negotiated abroad — is not remotely close to going into effect.
• Forcing drug companies to disclose prices in TV ads was a small gambit, and the courts ultimately struck down the idea.

The other side: The policies the administration has seen through, so far, have been relatively modest.

• New rules could force hospitals and health insurers to disclose their secret prices. Hospitals have sued, although the courts are not sympathetic to their pleas, and health insurers still have two years before their rule could go into effect.
• A federal appeals court upheld Trump's cuts related to a federal drug discount program for hospitals and hospital-based clinic payments, but the industry is considering taking the cases to the Supreme Court.
• Trump made it easier to sell short-term health plans.

Between the lines: Health care has consistently raked in large sums of profit every year of Trump's presidency. That has been especially true during the pandemic.

• Meanwhile, surprise medical bills are still a thing, consolidation hasn't stopped, lobbying has skyrocketed and federal coronavirus bailouts have favored affluent hospital systems over rural and safety-net hospitals.

A slew of European countries have announced new lockdowns over the last week in response to uncontrolled spread of the coronavirus.

Between the lines: Many of these countries are facing the threat of overrun health care systems in the near-term future and, potentially, harrowing decisions about how to ration care, the Washington Post reports.

• "An exponential phenomenon starts with very small numbers, and it is not tangible for weeks and weeks and weeks for people out there," Emmanuel André, a leading Belgian virologist, told the Post. "If you look at the numbers, you have very strong indicators early on that things are going wrong, but it is only at the very end that things explode."

What we're watching: The U.S. is on a similarly dire trajectory, although it's unclear how we'll respond.

Driving the news: A new national lockdown will be imposed in England, Prime Minister Boris Johnson announced Saturday, as the number of COVID-19 cases in the country topped 1 million.

• Austria announced a four-week nighttime curfew and the closure of cafes, bars and restaurants as another surge of coronavirus infections strains the country's health care system, according to Reuters.
• Greek Prime Minister Kyriakos Mitsotakis said over the weekend that most of the country will resume a coronavirus lockdown starting Tuesday, including closing restaurants, bars, cafes, movie theaters and gyms, AP reports.
• Belgium began enforcing a strict lockdown yesterday amid rising coronavirus infections, hospital admissions and a surge of deaths.

Americans increasingly have no idea where they're catching the virus, and contact tracing efforts are falling apart in the face of the sheer number of cases, NYT reports.

Why it matters: It's much easier to close down a meatpacking plant — or even contain an outbreak in a nursing home — than to contain a virus spreading rapidly through the population from an unknown number of origins.

Between the lines: The number of cases is several times above what experts say is realistic for contact tracing, and health officials in some places have given up on tracking the virus.

• Earlier on in the pandemic, uncontrolled spread was limited to a few major cities or specific regions, but it's now happening across the country.

The big picture: "The problem, of course, is that failing to fully track the virus makes it much harder to get a sense of where the virus is flourishing, and how to get ahead of new outbreaks," NYT writes.

• "But once an area spins out of control, trying to trace back each chain of transmission can feel like scooping cupfuls of water from a flood."

The bottom line: The U.S. has attempted to use a strategy of testing, tracing and isolation to keep the pandemic in check. But the virus is very much out of control, and this strategy is falling apart. That leaves a serious question of where we go from here.

Two companies behind an at-home rapid COVID-19 test are releasing encouraging clinical trial results ahead of applying for an emergency use authorization (EUA), company executives tell Axios' Bryan Walsh.

Why it matters: Antigen tests that could quickly provide results at home would be a major help in identifying and slowing the spread of COVID-19, but they have to get into the hands of consumers at an affordable price.

Driving the news: Cellex, a biotechnology company, and Gauss, a computer vision startup, announced this weekend that their rapid at-home coronavirus test achieved sensitivity rates of 94% and specificity rates of 97% compared to the PCR gold standard of lab tests, in a recent clinical trial.

• Sensitivity refers to a test's ability to identify true positive cases, while specificity refers to its ability to find true negatives.
• Those results are encouraging enough for the companies to move forward for an application for an EUA from the FDA, which is needed to fast track the test for home use.

The big picture: Cellex and Gauss are among dozens of companies racing to produce and market rapid at-home tests, but according to the Washington Post this week, no firm has yet applied to the FDA for authorization.

• One concern about at-home tests is that the results may not flow to officials, leaving them in the dark on COVID-19 spread, though Cellex and Gauss have partnered with a data integration platform to transmit test results.

18 Trump campaign rallies "ultimately resulted" in more than 30,000 incremental confirmed COVID-19 cases and "likely led to more than 700 deaths," researchers at Stanford University concluded in a study published Friday.

18 states set new highs last week for coronavirus infections recorded in a single day, according to the COVID Tracking Project and state health departments. Nine states surpassed records from the previous week, Axios' Orion Rummler reports.

NIAID director Anthony Fauci praised the Biden campaign's coronavirus stance, criticized White House adviser Scott Atlas and offered a bleak assessment of the U.S. pandemic response in an interview with the Washington Post, published Saturday.

Atlas apologized on Twitter for appearing Saturday on Russia's state-controlled RT network, where he insisted that the U.S. is turning the corner on the pandemic and that lockdowns are actually "killing people."

Former FDA commissioner Scott Gottlieb, who served under President Trump, said on "Face the Nation" Sunday that his "view is the inflection point will be Thanksgiving" on the coronavirus as the virus has surged throughout the country.