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This has been a feature of the pharmaceutical industry since the 90s. Ironically, pharmacy is one of the very few areas of healthcare where the dataset is fairly pristine - prescriptions are always entered into a computer, adjudicated electronically via a PBM (Pharmacy Benefits Manager) and eligibility and pricing is then transmitted back to the pharmacy. However, instead of this data being used for the benefit of the customer, it was used to essentially insert a middleman (the PBMs) into the path between the pharmacy and the insurer, and these grew to be large players over time. The contracting process between pharmacy->PBM and PBM->insurer allows for significant margins to be made by super chains like Walgreens and CVS (and their associated and owned PBMs), and at the end of the day, the customer gets hosed (via their insurance, or via paying cash on predatory "cash pricing" schemes which are massively profitable to the pharmacy itself). Independent pharmacies, unless they are in a particularly great location or have some other specialty, are more or less toast on their prescription business, and instead rely on front of house revenue. But even this is nothing when you dig into the hospital side of things, and some of the pricing programs that are available there. There are even specific drug pricing programs (like the 340B program) that are specifically designed to allow hospitals to save money on their pharmaceutical spend for certain classes of patients, but these programs can also be extended outwith the actual hospital's environment to the retail pharmacy. None of the anecdotes I just shared are Medicare/Medicaid related (more or less), and much of it (like 340B) are bandaids designed to try to help disproportionate share hospitals that act as a safety net for care for uninsured or indigent populations around the USA. My point is this - this is just the pharmacy side. The USA healthcare system is so complex, and involves so many layers, all of which are skimming profit in a nontransparent way, that it is no surprise that American healthcare is the most expensive in the world. Even diehard free market capitalists would be absolutely amazed if they truly knew what was happening under the hood, and whatever waste that exists in state run, single payer systems like the UK's NHS (or hell, even Medicare in the USA) pales in comparison to the profits being raked out of the system. |
Especially considering that there are plenty of examples around the world for doing better. When you look around Europe they all are very different but none of them is even remotely as f...ed up as the US system is.