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Illustration: Aïda Amer/Axios

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.

"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.

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.

  • The 2017 tax cuts and this year's tax cuts that were attached to the coronavirus legislation significantly benefited large health care companies that had massive cash reserves overseas or wanted easy tax refunds.

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.

  • Spending also continues to soar for people who get health insurance through their jobs because hospitals, drug companies and other providers still have no limits on how much they charge for their services and products, and because health insurers and employers always pass along the costs to everyone else.

Go deeper

22 hours ago - Health

U.S. exceeds 100,000 COVID-related hospitalizations for the first time

People wait outside the Emergency room of the Garfield Medical Center in Monterey Park, California on Dec 1. Photo: Frederic J. Brown/Getty Images

More than 100,200 Americans were hospitalized as of Wednesday due to the coronavirus for the first time since the outbreak began in early 2020, per the COVID Tracking Project.

The big picture: The milestone comes as health officials anticipated cases to surge due to holiday travel and gatherings. The impact of the holiday remains notable, as many states across the country are only reporting partial data.

Bipartisan group of lawmakers unveils $908 billion COVID stimulus proposal

Sens. Joe Manchin (D-W.Va.) and Susan Collins (R-Maine) in the Capitol in 2018. Photo: Tom Williams/CQ Roll Call

A bipartisan group of lawmakers on Tuesday proposed a $908 billion coronavirus stimulus package, in one of the few concrete steps toward COVID relief made by Congress in several months.

Why it matters: Recent data shows that the economic recovery is floundering as coronavirus cases surge and hospitals threaten to be overwhelmed heading into what is likely to be a grim winter.

18 hours ago - Health

Obama, Bush and Clinton willing to take coronavirus vaccine in public

Former Presidents Barack Obama, George W. Bush and Bill Clinton at Liberty National Golf Club in Jersey City, New Jersey, in 2017. Photo: Rob Carr/Getty Images

Barack Obama said during an interview on SiriusXM airing Thursday he'll take the COVID-19 vaccine and "may end up taking it on TV." Representatives for George W. Bush and Bill Clinton told CNN they'd also be willing to be inoculated in public.

Why it matters: The former presidents are hoping to instill confidence in the vaccines once authorized for use in the U.S. NIAID director Anthony Fauci has said the U.S. could have herd immunity by the end of next summer or fall if enough people get vaccinated.