When Donald Trump spoke about drug prices on 19 December, he struck a familiar note. Americans, he said, were paying far too much for medicines – and it was everyone else’s fault.

There would be no talk of reining in private insurers or pharmaceutical profits. Instead, Trump blamed foreign governments for getting a better deal. Countries like France, Germany and Japan, he argued, were piggybacking on the United States by keeping their drug prices low.

Later that day, at a rally in North Carolina, he performed an imaginary showdown with Emmanuel Macron. Trump claimed he had told the French president that France would have to double or triple its drug prices – and that France would ultimately give in. Thanks to this tough approach, Trump promised to cut US drug prices “by 700%”, a figure so nonsensical it barely merits scrutiny.

Trump is right about one thing: the US system is a public health failure. Drug prices are eye-wateringly high. Millions of Americans struggle to afford essential medicines such as insulin. Private insurers add costs without improving access. The result is a country that spends more on healthcare than anyone else, yet has lower life expectancy than many poorer nations.

But Trump’s explanation is wrong. Americans are not paying high prices so that European, Canadian,........

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