Reply #3: The problem is not so much the patents than the fact that the US govt,

[Mass]

because of its absence of a single payer system of one type or another, cannot negotiate with pharmaceutical companies for drug prices the way it is done in other countries.

In France, for example, in order for a drug to be reimbursed by the securite sociale, there is a negotiation that fixed the price it is sold and the margin the pharmacy will make (at least it was like that 10 years ago). One of the results was that drugs were basically 5 times less expensive than they were in the US for somebody without insurance (and state insurance reimbursed about 70 % of this, while a private insurance, if you had one, could reimburse the difference). This means that, at best, a French person would pay 6 % of the price a US person without insurance would pay, making drugs accessible to all or nearly all.

Of course, insurance companies negotiate with pharmaceutical companies and do not pay drugs full price. Neither do Medicaid, or the Veteran administration, but, because the negotiation is spread out, it is not as efficient as it would be in a single negotiation.

As for Medicare D, the stupid thing is that Congress did not vote the right to negotiate (though I am not sure whether this was changed or not).

I think that research costs is also an easy excuse from manufacturers. But why charge less if you can charge more.