They Were Caught Price-Gouging Americans in 1959. They Never Stopped.

In the fall of 1959, a Tennessee senator named Estes Kefauver sat a row of pharmaceutical executives down in a U.S. Senate hearing room and asked them, essentially, to explain themselves. The men across the table ran Merck, Pfizer, Schering, Bristol-Myers, Upjohn, and a handful of other household names, and Kefauver’s subcommittee had spent months quietly pulling their books apart. What his investigators found was not a rounding error. Prednisone was marked up 1,891% over the cost of making it. Reserpine was marked up 6,270%. Tetracycline, one of the most commonly prescribed antibiotics in the country, was marked up 1,557%. Most manufacturers were clearing margins north of 70%, and Kefauver’s staff turned up something almost poetic in its unfairness: the very same American-made drugs, sold in France, cost the French seventeen cents on the dollar of what they cost Americans.

Kefauver put it more plainly than any economist could. “The man who orders does not pay, and the man who pays does not order,” he told the room, describing a system where the doctor writes the prescription, the patient swallows the pill as well as the bill, and nobody standing between them has any reason to say no.

That was 66 years ago. The hearings were sensational enough that a Merck president sat before the cameras and offered his “deep sympathy” for Americans who couldn’t afford their own medicine, then went right on charging what the market — such as it was — would bear. When the dust settled, Congress did pass a bill. It gave us real drug safety standards, the kind that came directly out of the thalidomide tragedy that broke just as Kefauver’s legislation was stalling in committee. But the part of the bill that would have actually done something about price didn’t survive the process. The industry made sure of that. And so the fight Kefauver started went unfinished, reopened by some new committee every ten years or so since, always with the same villain and roughly the same math.

I bring this up because several of the companies that sat across from Kefauver in 1959 are still with us. They go by Merck, Pfizer, and Bristol Myers Squibb now, and they are still doing more or less exactly what they were doing then.

Merck makes Januvia, a diabetes drug. Fill that prescription in France today and it costs $200. Fill it in Canada and it’s $900. Fill it here, from the same company, and it’s $6,900. Bristol Myers Squibb make Eliquis, a blood thinner millions of Americans take every single day. In France, it’s $650. In Canada, $900. Here, $7,100 — for the same pill, made under the same corporate roof, sometimes in the same factory. 66 years and the seventeen-cents-on-the-dollar math Kefauver’s investigators found has barely moved.

Sound familiar? It should. This isn’t a new scandal. It’s an old one that Washington agreed a long time ago to stop noticing.

What Kefauver Couldn’t Finish, Congress Can Today

RAND has done with modern data what Kefauver’s staff did by hand: they found that American drug prices, across the board, run 278% of what patients pay in 33 other wealthy countries — and for brand-name drugs specifically, the gap widens to 422%. A Yale-led team went a step further and asked what it would actually be worth to close that gap. Their answer: $184 billion a year, if the United States simply paid what Canada, France, Germany, Japan, and the United Kingdom pay for the same drugs. Medicare’s drug spending would fall by 62% and the cost of treating diabetes, atrial fibrillation, and heart failure (the unglamorous, everyday diseases that quietly bankrupt American families) would drop by more than 75%.

But I didn’t need a research paper to tell me that.

Nearly 40% of Americans already know it, because they’re the ones cutting their pills in half, skipping the refill, doing arithmetic at the pharmacy counter that a Frenchman or a Canadian never has to do. That’s the real cost of the arrangement Kefauver couldn’t quite kill in 1959 and 1960. It doesn’t show up on a spreadsheet in Washington. It shows up in a kitchen, on a Tuesday night, when someone decides which half of the pill bottle needs to last until payday.

It keeps happening because Washington has let it keep happening. For every member of Congress walking the Capitol, there are three pharmaceutical lobbyists walking it with him. The industry spent more than $450 million on federal lobbying last year alone, and PhRMA’s own share of that — a record $37.9 million — bought quiet allies in places you wouldn’t expect: nineteen of the fifty-two outside groups that lined up to fight the Trump Administration’s drug-pricing tariff threats were funded, in whole or in part, by the pharmaceutical industry itself. When a lower European price threatens to become the new American benchmark, manufacturers have reportedly weighed simply not launching new drugs in parts of Europe at all, rather than let a fair price anywhere in the world become evidence against them here. That isn’t a company protecting a market . . . that’s a company protecting a scam, and it has been protecting it since before most of us were born.

Taking Their Best Argument Seriously

Big Pharma’s defenders will tell you all of this is the price of innovation — that if you touch the American premium, you starve the research pipeline that gives the whole world its medicine. It’s worth taking that seriously enough to actually check it, rather than just repeating it, because it doesn’t hold up. In 2020, 70% of the largest pharmaceutical companies spent more on sales and marketing than they spent on research and development, by a combined margin of $36 billion. The money that didn’t go to the lab went to stock buybacks, dividends, and executive compensation instead. Innovation was never what was being protected. Margin was.

They’ll also tell you this threatens access, and here they’ve simply got the diagnosis backwards. You cannot access a medicine you have already decided you cannot afford. Nearly 40% of Americans are living that sentence right now. Most Favored Nation pricing doesn’t touch a single FDA approval, doesn’t delay a single drug’s arrival on a single shelf. It touches the one thing that is actually standing between an American patient and their medicine . . . the price Big Pharma decided (unilaterally) that only Americans would pay.

And they’ll call it socialized medicine, government price-setting, the whole tired script pulled off the shelf every time reform gets close. It’s neither. Most Favored Nation pricing benchmarks off prices pharmaceutical companies already negotiated — voluntarily, in free markets, with foreign governments that drive a harder bargain than we ever have. Nobody in Washington is inventing a number out of thin air. Congress is simply asking American drugmakers to honor the price they already signed their name to somewhere else.

President Trump Opened the Door. Congress Has to Walk Through It.

In May of 2025, President Donald J. Trump did something four administrations before him would not: he told the pharmaceutical industry, directly, that the free ride on the backs of American patients was over and he ordered prices be brought in line with what the rest of the developed world pays. By December, seventeen companies had signed on. That’s not a symbolic gesture . . . that’s leadership that produced results in a fight that had been stalled since Kefauver’s era.

But an Executive Order is a promise with an expiration date stapled to it. Those seventeen agreements are voluntary and every one of them sunsets in three years. Dr. Benjamin Rome at Harvard Medical School, who has spent his career studying how drug prices actually move, put it plainly: without legislation, the agreements “will not significantly impact pricing decisions.” A future administration — or a single well-funded lawsuit — could unwind the whole thing in an afternoon.

This is where Congress either finishes what Kefauver started or lets Big Pharma win the round again, the way it always has. The vehicle already exists: H.R. 3493, the Global Fairness in Drug Pricing Act, which would take the standard President Trump ordered and carve it permanently into law — reaching not just Medicare and Medicaid, but the commercial market where most Americans actually get their prescriptions. It was introduced by Congressman Ro Khanna, a California Democrat, and it carries the support of Congresswoman Anna Paulina Luna, a young Florida Republican who has been one of its loudest and most effective voices.

“For decades, Big Pharma has lined its pockets by ripping off American consumers,” Luna said when the bill was introduced, and she meant it as an indictment of both parties equally, because she’s right that both parties let it happen. This is exactly the kind of leadership this fight has been missing for six decades — young, unafraid of the industry’s checkbook, and willing to work across the aisle because the arithmetic doesn’t care what letter is next to your name.

An Electorate Done Being Patient

This is also, not by coincidence, a midterm cycle where affordability is the whole ballgame. Voters are not asking Washington for more theater. They are asking who is actually going to make their lives cost less, and they have already started punishing candidates who can’t answer the question. Louisiana Republicans didn’t send Bill Cassidy back to the U.S. Senate this spring; they sent Congresswoman Julia Letlow forward instead, part of a broader mood among primary voters that has no more patience for comfortable incumbency.

Texas Republicans did something even more dramatic, retiring a four-term senator in John Cornyn and handing the nomination to Texas Attorney General Ken Paxton by nearly thirty points. You don’t have to read every one of those results as a referendum on drug prices specifically to see the shape of the thing: this is an electorate that has stopped giving Washington the benefit of the doubt, on this issue and nearly every other one that touches a grocery bill or a pharmacy counter. A Congress that fails to act on Most Favored Nation pricing heading into November is not reading the room.

Finish the Sentence

U.S. Senator Estes Kefauver never got to close his own case. He dies in 1963, a year after his amendment passed with the price provisions stripped out of it, the fight he started still unfinished. 66 years is a long time for a piece of unfinished business to sit on a shelf in the United States Capitol.

Congress does not need a new idea. It has had the right one since before most of the currently serving members were born. It simply needs the nerve to pass H.R. 3493, put the President’s Executive Order into permanent law, and finally tell Big Pharma that has learned to treat the American patient as the one customer who never gets the good price . . . “Not anymore.”

Rob Burgess is a national Republican strategist, and Chief Executive Officer at Connector, Inc. — a boutique government relations, public affairs, and political strategy firm with offices in Washington, D.C.