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Of the parts of the world, other than the US, that I'm most familiar with, Japan and Western Europe, they control drug prices - and keep them low.

I've had a theory for a while that the way world drug companies make up for low profitability in those markets is in gouging in the US where it's a free-for-all and one should grab for as much as one can get.

The totality of US healthcare is a big, complicated $3+ trn/yr pie but there's flagrant abuse all over the system (and a variety of intl players, profitably for them, contribute) and pharmaceutical companies are eager to be in on the game.

I wonder what would happen to healthcare globally if the US were able to downsize its 20%-of-gdp system to something on the order of Western Europe or Japan which is to say 10% of gdp? That is, the revenue the system generates would drop by half.

Needless to say, there'd be resistance tantamount to, let's call it, institutional violence. US doctors' earnings cut in half? You've got to be kidding.

> the way world drug companies make up for low profitability in those markets is in gouging in the US where it's a free-for-all and one should grab for as much as one can get.

It's much simpler. They don't "make up" for anything, they just grab as much as they can get, everywhere. It just happens that in the US they can get more, and as the amoral, self-interested entities they are, they don't leave any money on the table.

No major company will say "Our profits are up in market A, so we should reduce profit in market B to compensate."

What leads you to believe that cutting drug prices would cause doctors' earnings to fall?

There is gross waste at every layer. The AMA artificially keeps doctors' earnings higher than they would be in a system that could respond to demand.

How are they keeping earnings high?

Restricting supplies of doctors.

How is that supply restricted? Medical schools are pretty much full, but many schools are going to great lengths to expand available spaces. Med school enrollments are up about 30% since the early 00's. It's true that at some point in the 90's the AMA was predicting an over-supply of doctors, but they quickly realized that wasn't the case and reversed course, as evidenced by their own (successful) efforts to help schools increase enrollment (https://www.aamc.org/system/files/reports/1/enrollmentreport...)

Additionally, restricting the functions of nurses, physicians assistants etc in the process.

A lot of things that doctors do (because people want doctors and doctors want doctors to be in demand) could be done by nurses with special training.

Physician income and drug prices are entirely unrelated, except for the oncologists whose salary derives from reselling onco drugs.

That you think they are somehow related strongly undermines the rest of your post, as it suggests you are very weakly acquainted with the details of our healthcare system.

This is an interesting theory to play around with. If you look at the regional revenues listed on Bayer's site[0] North America accounts for €15.1 billion of revenue, while Europe/Middle East/Africa accounts for only €13.2 billion and Asia/Pacific €8.6 billion. That is quite the gap which could be caused by high US prices, but it warrants a look into the industry's financials.

[0] https://www.bayer.com/en/worldwide/bayer-worldwide

In Brazil they control the prices and keep them... high.

So maybe people in Europe and Japan should say thank you to US citizens that pay more for medicines.

Alternatively, people in countries outside the US should be peeved at the US for protecting the US-based companies that gouge everyone, everywhere. ;)

Japan has the 2nd highest drug prices globally. It's actually a very significant market for that reason.

And in terms of drug prices in Western Europe, it really depends. One example, orphan drugs for rare diseases, the prices are actually pretty comparable to the US. These are the drugs that are several hundred thousand dollars per year.

A good example is Glybera, a gene therapy never approved in the US. The price in Germany was ~$1M USD.

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