A bit unrelated - but I always thought the American concept of "annual checkups" sounded a bit weird. Here where I come from, Norway, that is not a thing - unless you have / or have had some serious illness in the past. Obviously cancer patients, or those in remission, get checked up every x months.
But for regular people, it's pretty much not a thing. It also made me wonder: How much more would it cost our health-care system, if everyone took advantage of things like annual checkups, or going through those extensive screens/tests that a lot of American patients go through. I guess the fear of malpractice lawsuits, higher insurance rates, or whatever make the medical centers in US a bit more incentivized to catch anything at all.
But AFAIK, we don't have any higher mortality rate here than those living in the US. Earlier this year I went to the doctor, because I was feeling a bit lethargic - turned out I had severe vitamin D deficiency. But other than that, it must be 7-8 years since I talked with a doctor.
(But credit where credit is due - the US seems like an excellent option IF you really need to get treated for certain cancers. It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)
Just FYI, annual checkups are recommended, but certainly something that a lot of young people skip. A quick google shows that only around 60% of Americans see a doctor yearly.
The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.
If you are male, your life will probably be wrecked at some point by a heart attack/stroke or prostate/bowel cancer. The risk of cardiovascular disease can be reduced in various ways. You also might have rarer but more significant risk factors for premature death from cardiovascular disease (eg Lp(a)). There is still an unacceptably high rate of death or severe disability from the primary cardiovascular event ie. you don't get a second chance, as the first sign of the disease can be fatal or disable you permanently. The screening tests one has in an annual checkup are not 'extensive' really, it is asking questions about lifestyle and family history, checking lipids, routine bloods, blood pressure and doing cancer screening after certain ages. The chance of an incidental finding resulting in harm is very low with this kind of thing.
Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense.
I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?
> I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.
The US is outstanding at taking money from sick people, just not any better at getting them well.
Not to defend anything about the American model (I personally hate it and think it's broken) but the annual checkup is a very cheap way of dealing with a possibly expensive condition.
The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'.
> How much more would it cost our health-care system, if everyone took advantage of
Annual checkups are definitely not the reason healthcare costs are sky-high in the US.
> It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)
This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.
Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures
(And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)
Part of the reason why it’s a thing in the US is that a huge number of people do have/have had a serious illness in the past: heart disease, diabetes, obesity, etc. Part of the reason they have those illnesses is because they neglected their health due to the cost of prevention.
Wait a sec: mammograms, postate exams, colonoscopies? You don't have these regular screenings when you hit a certain age? AFAIK, the data is very good on the early detection power of these exams.
Since we spend twice as much as anyone else on healthcare but rank somewhere around 50th in lifespan, it would be weird if we were getting better outcomes in any area due to greater spending.
As a researcher in the field and someone who has seen a few friends go due to cancer, the current standard of care is very frustrating.
I believe cancer is orders of magnitude easier to treat when it is still asymptomatic but detectable using metrics such as circulating tumor DNA (ctDNA). However, it is taking ages to deploy this technology because healthcare struggles with any data-oriented solution.
Healthcare is notoriously slow with adoption of new technology. IMO this is because healthcare is fee-for-service, which is basically incompatible with prevention. A movement to value-based care would vastly improve adoption of preventive and personalized healthcare.
Very true. The headline is misleading though. The actual article is framed as the inverse: "does spending more on cancer care give the US better outcomes?" and the answer is no. We're on par with other wealthy countries that spend half as much per person on cancer care.
So yeah, the exorbitant costs of US healthcare do not correlate with better health outcomes. Just worse financial outcomes.
We shouldn't expect outcomes to be much different, because when someone gets cancer in the rich world, they get treated with whatever medical science thinks is best. Contrast that with an ordinary purchase like a washing machine.
What's left when you're definitely going to buy the Cadillac is that the price depends on how much money you have, and Americans tend to be wealthy.
It also depends on factors relating to restriction of competition. If there's only so many doctors, which is the case because they restrict how many can be trained, doctors can extract more. Add to that the fear of litigation (friend dated a girl whose father made a living suing US doctors) and they end up spending money on tests that they wouldn't in the rest of the west. Possibly collective purchasing in national systems means something too, not sure.
These analyses are very crude. How do they work out spending on cancer care? They take total spending and get the % spent on cancer care. % spent on cancer care is a published figure, it is not calculated directly. In single payer systems, like Australia, the true costs of cancer care are probably submerged in broader healthcare spending. The comparison is also unfair because of drug costs. Essentially, drug companies know they can make a lot on cancer drugs in the USA [1]. This means that they are more willing to negotiate lower prices in other smaller countries. There is also the fact that the crazy legislation in the USA prevents price negotiations. The USA is in a way subsidising cancer drugs for the rest of the world.
I also think it is impossible to really compare cancer mortality between countries. My take on these figures is that given how big and dirty the USA is, they are doing remarkably well to have mortality that is significantly lower compared to smaller wealthy countries.
Healthcare spending is almost as unequal as wealth, with a tiny minority consuming most of the resources [0]. Don't have data for this, but I see no reason not to assume a similar distribution applies to groups like cancer sufferers. That is - those most likely to die account for most of the cancer spending, while those with good outcomes account for relatively little. If you set a per person spending cap, you could expect a great reduction in per capita spending without much impact on aggregate outcomes (perhaps even an improvement). Which is exactly what public healthcare systems effectively do by strict rationing and discouraging private spending.
^ looks into more granular data, surveys sources that show +/0/- correlation between spending + outcomes, compares end-of-life vs non-end-of-life, cites a few studies about specific cancer types, wasteful spending. Does a better job of investigating international change in spending vs outcomes over time.
the OP globocan paper is using a country average; averages don't tell you that much, esp in the US.
cancer data is very granular these days (NY mandates per-case reporting, for example https://www.health.ny.gov/statistics/cancer/registry/about.h...). would be interesting to have a live model somewhere of outcomes by cancer, stage, comorbidity + hospital
Cancer Care costs are insane..my mom is being treated for breast cancer..each chemo infusion cost $65k to her insurance company. Her surgery to remove her left breast cost $165k. 5k going to the surgeon fee while the rest was a facility fee. It's been less than a year now and the insurance has paid out almost a million dollars.
>each chemo infusion cost $65k to her insurance company. Her surgery to remove her left breast cost $165k. 5k going to the surgeon fee while the rest was a facility fee. It's been less than a year now and the insurance has paid out almost a million dollars.
Do you know that your insurance paid that, or is it what you have been quoted?
US hospitals are notorious for overcharging by factors of ~10x when looking at their charge master, but the insurance companies will get a much better price after negotiating with the hospital, which is one of the reasons why the hospitals will blow-up charges in the first place, to get paid despite the insurance companies not paying everything.
It's a broken system because you need an insurance agent as a "lawyer" to get the real rates.
Instead what is necessary is price competition and transparency. You should be able to look up online the cost of chemotherapy for a certain type of cancer in the whole US, then you can filter by distance, reviews and price. The price on the sticker has to include everything. Whether you have insurance or not should not factor into the price at all.
The free market is maybe not a solution to the social problem here, but it could at least drive down costs.
My Mum was diagnosed with stage 4 lung cancer - had 2.5 years of radiation, chemo and monthly doctor visits. Saw many specialists, etc. etc.
Never saw a single bill, and in fact was paid actual money for the inconvenience of having to drive 3.5 hours to a bigger facility that had equipment the local small-town hospital did not. Also got a free apartment to stay in for those out of town appointments, meal allowance, etc.
Mum had never paid a cent in insurance premiums in her life, etc.
This mirrors my personal experience. To make a treatment decision, against the advice of my local doctors, that was key to survival I relied on US research.
To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD.
Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here.
Public healthcare being adequate is somewhat of a myth, for Germany at least.
on the research side, this would tend to reduce prices, right? clinical trials usually aren't charging (per [1]).
this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down?
Do you have any data to backup your claim? For example Cuban healthcare/treatment/outcome is excellent based on its own research. Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies.
> “The pattern of spending more and getting less is well-documented in the U.S. healthcare system; now we see it in cancer care, too,” said co-author Elizabeth Bradley
It's a cynical viewpoint, but I can forgive those who think that modern health care is mostly a way to extract as much wealth as possible from sick people before they die.
Having dealt with end of life Healthcare for a family member who dies of cancer, I'm curious how you can see it any other way. It is purely wealth extraction at end of life.
When you lose you job and insurance due to health, you can not qualify for state aid if you have any assets at all. you you must spend until you are broke before you get any help. Then there is the issue of nursing homes. If you end up in one, they have the ability to unwind any asset transfers in the previous 5 years, so if you thought you can transfer your house to your children before you die, you can not. The nursing home and the hospitals will suck every penny out of an estate and the only way to prevent it is to die quickly.
But this is adjusting for the baseline illness, remember. This isn't just age-standardised mortality rates. It's disease-standardised mortality. Hopefully they've adjusted for confounders...
The relatively poor average quality of healthcare was made apparent in covid pandemic where US had among the highest mortality rates and deaths per capita in the developed world [1]
And I do not need data to tell me this, just overal experience comparing it to my previous experience getting healthcare in Europe leaves a lot to be desired.
Getting medical care in US is hard with a lot of bureaucratic/insurance overhead and when you finally get to the doctor they are more prone to follow strict procedures/checklists to reduce liability instead of being genuinly curious about your condition.
And all this while most have to pay astronomical price for healthcare out of their pocket. Not sure that the case for privatised healthcare can hold up with these results.
While your premise may not be wrong, I'm not so sure that COVID statistics can tell us much between countries. There are a great deal of countries that are either wholly inadequate, or purposefully misleading when it comes to their true COVID numbers.
For example, India has an official COVID death count of around 500k. The WHO has made their own estimates and believe their death count to be closer to 5 million, ten times the official number.
> The relatively poor average quality of healthcare was made apparent in covid pandemic where US had among the highest mortality rates and deaths per capita in the developed world
This discounts the fact that the vast amount of money spent on Medical practices is in the US which causes the advances here. Once the advances happen though they're global, so the US does not get the benefits from that money.
This "tragedy of the commons" with regards to medical science causes everyone to misattribute things. Europe for example can pay little money for their medical practices because of the US bankrolling the research and drug development that allows them to do so.
One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.
I work in the drug development industry, its a shame this has been downvoted, it's largely true - at least for new drug innovation. The fact that routine procedures are expensive in the US is unrelated.
The US is ~35% of the global pharmaceutical industry, which is the topline driver of new drug development.
When the US pays top dollar for new drugs, it does effectively subsidize European access to the new research.
> One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.
Then you'd end up bankrupting most healthcare and pharmaceutical companies, that is if most of them don't leave the country. If the current scenario is a "tragedy of the commons" a la Guns or Butter, then the US's domestic medical policy is the biggest contributor. A "most favored nation" policy as such just allows the government to pick winners and losers by creating a de facto price control. It's not a solution and would do more harm than good.
The ultimate reason why it's expensive to sell a drug in the United States is because the FDA makes it illegal to import competing drugs. The solution is to let the market determine the "real" prices.
> they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement
Drug prices are far from the leading cause of the high cost of US healthcare.
The whole system is deeply dysfunctional with massive perverse incentives.
Do you have the numbers to back these claims? Is the extravagant money spend on healthcare in US actually drives everything ahead? Do countries like UK, Germany, Switzerland and Japan lag behind due to the smaller amounts spent?
[+] [-] TrackerFF|3 years ago|reply
But for regular people, it's pretty much not a thing. It also made me wonder: How much more would it cost our health-care system, if everyone took advantage of things like annual checkups, or going through those extensive screens/tests that a lot of American patients go through. I guess the fear of malpractice lawsuits, higher insurance rates, or whatever make the medical centers in US a bit more incentivized to catch anything at all.
But AFAIK, we don't have any higher mortality rate here than those living in the US. Earlier this year I went to the doctor, because I was feeling a bit lethargic - turned out I had severe vitamin D deficiency. But other than that, it must be 7-8 years since I talked with a doctor.
(But credit where credit is due - the US seems like an excellent option IF you really need to get treated for certain cancers. It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)
[+] [-] dghlsakjg|3 years ago|reply
The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.
[+] [-] Gatsky|3 years ago|reply
Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense.
I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?
[+] [-] pessimizer|3 years ago|reply
The US is outstanding at taking money from sick people, just not any better at getting them well.
[+] [-] decebalus1|3 years ago|reply
The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'.
> How much more would it cost our health-care system, if everyone took advantage of
Annual checkups are definitely not the reason healthcare costs are sky-high in the US.
[+] [-] bnjms|3 years ago|reply
This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.
[+] [-] raverbashing|3 years ago|reply
Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures
(And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)
[+] [-] paulcole|3 years ago|reply
[+] [-] lr4444lr|3 years ago|reply
[+] [-] sneak|3 years ago|reply
You don't get annual bloodwork performed? Does your cat/dog?
[+] [-] david_l_lin|3 years ago|reply
Well yeah, the cost of healthcare in the US is astronomical. https://www.healthsystemtracker.org/chart-collection/health-...
This would be the same across diseases, not just cancer.
[+] [-] pessimizer|3 years ago|reply
[+] [-] nextos|3 years ago|reply
I believe cancer is orders of magnitude easier to treat when it is still asymptomatic but detectable using metrics such as circulating tumor DNA (ctDNA). However, it is taking ages to deploy this technology because healthcare struggles with any data-oriented solution.
[+] [-] david_l_lin|3 years ago|reply
[+] [-] adammunich|3 years ago|reply
[+] [-] vimy|3 years ago|reply
[+] [-] asdff|3 years ago|reply
[+] [-] salt-thrower|3 years ago|reply
So yeah, the exorbitant costs of US healthcare do not correlate with better health outcomes. Just worse financial outcomes.
[+] [-] lordnacho|3 years ago|reply
What's left when you're definitely going to buy the Cadillac is that the price depends on how much money you have, and Americans tend to be wealthy.
It also depends on factors relating to restriction of competition. If there's only so many doctors, which is the case because they restrict how many can be trained, doctors can extract more. Add to that the fear of litigation (friend dated a girl whose father made a living suing US doctors) and they end up spending money on tests that they wouldn't in the rest of the west. Possibly collective purchasing in national systems means something too, not sure.
[+] [-] Gatsky|3 years ago|reply
I also think it is impossible to really compare cancer mortality between countries. My take on these figures is that given how big and dirty the USA is, they are doing remarkably well to have mortality that is significantly lower compared to smaller wealthy countries.
[1] Fig 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641070/
[+] [-] auganov|3 years ago|reply
[0] https://www.healthsystemtracker.org/chart-collection/health-...
[+] [-] awinter-py|3 years ago|reply
Association Between Spending and Outcomes for Patients With Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994252/
^ looks into more granular data, surveys sources that show +/0/- correlation between spending + outcomes, compares end-of-life vs non-end-of-life, cites a few studies about specific cancer types, wasteful spending. Does a better job of investigating international change in spending vs outcomes over time.
the OP globocan paper is using a country average; averages don't tell you that much, esp in the US.
cancer data is very granular these days (NY mandates per-case reporting, for example https://www.health.ny.gov/statistics/cancer/registry/about.h...). would be interesting to have a live model somewhere of outcomes by cancer, stage, comorbidity + hospital
[+] [-] MauroIksem|3 years ago|reply
[+] [-] carlmr|3 years ago|reply
Do you know that your insurance paid that, or is it what you have been quoted?
US hospitals are notorious for overcharging by factors of ~10x when looking at their charge master, but the insurance companies will get a much better price after negotiating with the hospital, which is one of the reasons why the hospitals will blow-up charges in the first place, to get paid despite the insurance companies not paying everything.
It's a broken system because you need an insurance agent as a "lawyer" to get the real rates.
Instead what is necessary is price competition and transparency. You should be able to look up online the cost of chemotherapy for a certain type of cancer in the whole US, then you can filter by distance, reviews and price. The price on the sticker has to include everything. Whether you have insurance or not should not factor into the price at all.
The free market is maybe not a solution to the social problem here, but it could at least drive down costs.
[+] [-] grecy|3 years ago|reply
Never saw a single bill, and in fact was paid actual money for the inconvenience of having to drive 3.5 hours to a bigger facility that had equipment the local small-town hospital did not. Also got a free apartment to stay in for those out of town appointments, meal allowance, etc.
Mum had never paid a cent in insurance premiums in her life, etc.
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] xqcgrek2|3 years ago|reply
They don't bear the cost so expecting the US to do better at same or lower cost is structually impossible.
[+] [-] biorach|3 years ago|reply
Is the cost of funding the "research complex" included in the expenditure on health care?
At least some of this cost is born by the Federal government, foundations etc, is this counted as general health care expenditure (I doubt it)
Some of the research is funded by companies - since they sell globally this funding cannot be counted as purely of US origin.
Other countries also have significant health research - e.g. UK, France, Germany - your point would also apply to them.
Overall your point is dubious, and vague - you'd need to present some solid numbers to back it up.
[+] [-] byecancer21|3 years ago|reply
To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD.
Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here.
Public healthcare being adequate is somewhat of a myth, for Germany at least.
[+] [-] awinter-py|3 years ago|reply
this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down?
1. https://www.hhs.gov/ohrp/sachrp-committee/recommendations/no...
2. https://www.healthaffairs.org/do/10.1377/forefront.20170307....
[+] [-] cjbenedikt|3 years ago|reply
[+] [-] lr4444lr|3 years ago|reply
[deleted]
[+] [-] SoftTalker|3 years ago|reply
It's a cynical viewpoint, but I can forgive those who think that modern health care is mostly a way to extract as much wealth as possible from sick people before they die.
[+] [-] frogperson|3 years ago|reply
When you lose you job and insurance due to health, you can not qualify for state aid if you have any assets at all. you you must spend until you are broke before you get any help. Then there is the issue of nursing homes. If you end up in one, they have the ability to unwind any asset transfers in the previous 5 years, so if you thought you can transfer your house to your children before you die, you can not. The nursing home and the hospitals will suck every penny out of an estate and the only way to prevent it is to die quickly.
[+] [-] rr808|3 years ago|reply
[+] [-] jphoward|3 years ago|reply
[+] [-] freediver|3 years ago|reply
And I do not need data to tell me this, just overal experience comparing it to my previous experience getting healthcare in Europe leaves a lot to be desired.
Getting medical care in US is hard with a lot of bureaucratic/insurance overhead and when you finally get to the doctor they are more prone to follow strict procedures/checklists to reduce liability instead of being genuinly curious about your condition.
And all this while most have to pay astronomical price for healthcare out of their pocket. Not sure that the case for privatised healthcare can hold up with these results.
[1] https://coronavirus.jhu.edu/data/mortality
[+] [-] jjeaff|3 years ago|reply
For example, India has an official COVID death count of around 500k. The WHO has made their own estimates and believe their death count to be closer to 5 million, ten times the official number.
[+] [-] mlindner|3 years ago|reply
This has nothing to do with healthcare quality.
[+] [-] mlindner|3 years ago|reply
This "tragedy of the commons" with regards to medical science causes everyone to misattribute things. Europe for example can pay little money for their medical practices because of the US bankrolling the research and drug development that allows them to do so.
One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.
[+] [-] mjewkes|3 years ago|reply
The US is ~35% of the global pharmaceutical industry, which is the topline driver of new drug development.
When the US pays top dollar for new drugs, it does effectively subsidize European access to the new research.
>Do you have any data to backup your claim?
I would suggest https://www.rand.org/pubs/research_briefs/RB9412.html
or the Great American Drug Deal, by Peter Kolchinsky.
[+] [-] Dracophoenix|3 years ago|reply
Then you'd end up bankrupting most healthcare and pharmaceutical companies, that is if most of them don't leave the country. If the current scenario is a "tragedy of the commons" a la Guns or Butter, then the US's domestic medical policy is the biggest contributor. A "most favored nation" policy as such just allows the government to pick winners and losers by creating a de facto price control. It's not a solution and would do more harm than good.
The ultimate reason why it's expensive to sell a drug in the United States is because the FDA makes it illegal to import competing drugs. The solution is to let the market determine the "real" prices.
[+] [-] biorach|3 years ago|reply
Drug prices are far from the leading cause of the high cost of US healthcare.
The whole system is deeply dysfunctional with massive perverse incentives.
[+] [-] mrtksn|3 years ago|reply
[+] [-] biorach|3 years ago|reply
Do you have any articles, papers etc from reputable sources to back this up? Or is this just personal speculation?