When President Donald Trump arrived in the United Kingdom this week, he landed bang in the middle of a huge political fight about the country’s National Health Service.

One of the biggest issues in the UK election slated for December 12 is what a trade deal with the United States after Brexit might look like, and whether or not it would allow American pharmaceutical companies to charge the NHS more for their drugs.
There’s a huge amount at stake. The United Kingdom is a wealthy nation with an aging population and a state-funded health care system. The King’s Fund, a health policy think tank, estimates that the NHS spent $22.7 billion on medicines in England alone in 2017. Billions more would have been spent in Scotland, Wales and Northern Ireland.

Not very much of that money was spent on US imports. For example, the US drug industry exported nearly $56 billion in biopharmaceuticals in the same year, according to PhRMA, a trade association, but the United Kingdom accounted for only $3.6 billion of that haul.

PhRMA declined to comment for this story, but earlier this year it urged US trade negotiators to bring home a deal that would boost exports to the United Kingdom.
Both main British political parties have made misleading claims during the campaign. Jeremy Corbyn, leader of the opposition Labour Party, says that Prime Minister Boris Johnson is so eager to strike a trade deal with Trump that he will sell out the NHS, exposing it to higher prices for prescription drugs and allowing services to be privatized. Johnson has repeatedly said that the NHS is not, and never will be, on the table in trade talks.

The reality is more complicated. It’s unlikely that many US companies want to take over large parts of the bureaucratic NHS. But securing a bigger share of the British market for American pharmaceutical companies such as Pfizer (PFE) and Merck (MKGAF) would be a big prize for US trade negotiators.
Fueling concern in the United Kingdom is the fact that prescription drugs cost more in the United States than almost anywhere else on the planet. And the United States spends more than double the United Kingdom per capita on medicines.