Doesn't that go both ways? Eli Lilly is a huge organization negotiating in favor of higher prices, so it makes sense that a huge organization (i.e. the government or insurance companies) would be needed to negotiate against them.
Even if there is a power imbalance between Eli Lilly and the Canadian Government, there would also be a power imbalance if it was instead Eli Lilly vs. individual consumers.
Eli Lilly actually doesn’t negotiate for higher prices. I’ve had somewhat more insight than the average person into how the dynamics of the insulin pricing work, and it’s a total abomination, largely born out of a lack of a universal public insurance option in the US.
Despite the skyrocketing costs of insulin over the decades, Eli Lilly’s profits per unit are mostly in line with inflation. This is because in the US system, there is a pervasive system of rebates that exists between pharmaceutical companies and insurers. Insurers often may only pay 10% of what the sticker price is for insulin. But the way these rebates get negotiated through third party firms known as PBMs create a system that incentivizes insulin that is marked up an incredible amount and then discounted to X, than simply pricing it at X in the first place. But this obviously screws over anyone without access to the rebate, i.e. those without insurance. And this system largely exists because the privatized nature of insurance in the US. If there was some kind of universal medicare in the US, undermines those incentives and the market would normalize immediately.
> If there was some kind of universal medicare in the US
You don't even need that. Just more/better regulation would suffice. You have countries with fully privatized healthcare systems like Switzerland or partially privatized ones like Germany or Netherlands which have no such problems.
> The problem is the regulation that mandates people have insurance or be punished
Which is the cornerstone of any universal healthcare system? It only works in other countries if the healthy subsidize the costs of those less fortunate.
Also Switzerland had compulsory fully private insurance. To be fair they do suffer from similar issues as the US. Healthcare prices are very inflated compared to the surrounding countries, accessibility to some services (e.g. dental) is poor for low income individuals etc.
Of course it helps that Switzerland is a quite homogenous, has low inequality and subsidize access for low income individuals. However inherently the system is not that different from the one in US (I mean Switzerland is closer to US than either is to Britain).
Even if there is a power imbalance between Eli Lilly and the Canadian Government, there would also be a power imbalance if it was instead Eli Lilly vs. individual consumers.