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My point is that when a highwayman says "your money or your life" we call it a crime. He gets lots of money because those are the choices. But those are the choices which, in the USA, pharma and other medical professionals offer. They can charge enormous amounts because these are the conditions. Does it cost a lot to develop drugs? Sure. But the profits more than cover the costs. Obviously. This market sector is hugely profitable. Other people who solve difficult problems where their potential customer isn't desperate cannot achieve equivalent profits.

If you work in medicine you have lots of ways to wash your conscience. Medical school is hard and expensive! You are saving lives! But in the end you can charge the rates you charge because your customer is desperate (to say nothing of the information asymmetry, the cost and difficulty of seeking a second opinion, etc.). There is a huge market failure here and that is the source of your enormous profit.

There are many alternative ways to achieve the same end without the market failure fleecing the unfortunate in the middle. Offer bounties for medical breakthroughs. Finance healthcare as a public good. This will reduce the rate of improvement in medical science because the payoff for breakthroughs will be less. Maybe this is the wrong way to go about it. But I'd rather take my chances with a less broken medical system. I've been fleeced many times in my life by the US healthcare system. If I have to sacrifice my well being for some cause, there are others I'd prefer. Will innovations slow if the US stops being a patsy? Yes. But I'd just like access to the medicine we already have.



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