[rayiner]

> It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening strategies, ideological opposition to functional and prove reforms, and good old fashioned cronyism.

It’s funny what “differences” people choose to fixate on. For example, patent systems are very similar between the US and Europe. And I doubt you can quantify any difference in “cronyism.” Supply of medical professionals, and doctor salaries, are quite different. So to are limits on what the state will pay for end-of-life and terminal care. (For example, when you see stories about people reaching their lifetime limit on insurance in the US, go check if the UK NHS’s death panels would have allowed anywhere near those expenses under their QALY calculations.)

I’d also love to hear your theory for how pharmaceuticals are a “natural monopoly.” EU countries lower drug prices through good old monopsony (single buyer), which has similar detrimental effects to a monopoly (single seller). They just get away with it because the US continues to resist such efforts.