[bobdole1234]

Not so much fixed as "Canada doesn't insist that everyone make separate deals so everyone can get fucked harder".

It turns out when you have millions of people dealing together as a block, they have much more bargaining power.

[refurb]

That's not why Canada gets better prices. United Healthcare has 42M members which is bigger than the entire population of Canada.

[dlitz]

Yes, apparently Canada has something called the Patented Medicine Prices Review Board:

http://pmprb-cepmb.gc.ca/about-us/frequently-asked-questions

[dredmorbius]

It's not merely size. It's size-relative-to-market.

Canada negotiates with drugs suppliers. Supplier says "take a hike". Canada says, "OK, you're out of the market", turns to next drug supplier.

Canada here has right-of-refusal, and can negotiate, as a single block entity, with ability to restrict market, to each. The drugs company which finds those terms acceptable has a market.

A bloc of 42 million in the US is only about 12% of the total market. The discussion there still leaves another 290M possible customers for a drugs vendor. Hence the strength is with the vendors.

If US Medicare had rights to exclusively negotiate drugs deals (it doesn't), this would change tremendously. Similarly for single payor.

Which is precisely why the entire medical services industry is so mortally opposed to it. They'd lose absolutely all market leverage. They know this.

[toomuchtodo]

I agree. My hack is safer than 3D printing medical devices, as its simply a geographical arbitrage.

Thank you Canada.