[skissane]

> Healthcare is one of the most regulated industries in the United States.

And yet other countries have even more regulation, and manage to deliver cheaper and more equitable healthcare overall, with better public health outcomes when measured at the national level

For example: in Australia, the federal government is a near-monopsony purchaser of prescription drugs, so it has enormous negotiating power with the pharmaceutical companies. By contrast, in the US, the federal government’s role in purchasing drugs is much smaller: the end result is higher drug prices, although the downside of Australia’s model is it can delay availability of new drugs. (Those with unlimited ability to pay can still purchase drugs privately at whatever cost the manufacturer will sell them-you can even get bureaucrat approval to import unapproved drugs for personal use if you can find a senior clinician willing to assist you in it.)

[ipaddr]

Most Americans don't want equitable healthcare they want the best they can afford and they want the newest treatments available.

The waiting for the patent to expire and buying in bulk keep down the costs down works. The US couldn't use the generic strategy because the drug companies get funded and create the new drugs this way. Cutting off the funding would mean no new drugs to copy so no new generics. Australia would have to start funding research.

[donavanm]

As sibling mentioned thats not the model. From what Ive seen australia lags US access on the order of 6months to a few years for most things. Effectively theres an additional review period where TGA reviews foreign research and approval before (generally) allowing and entering it to the ARTG and PBS with the relevant prescribing advice. Once its on the MBS/PBS the patient gets access through their prescriber and/or chemist.

The PBS listed medications are essentially price capped copays at the point of sale, with the bulk of the cost covered directly by the government (who negotiates prices with the manufacturer, and fronts the pharmacist distribution costs). Its the same pfizer etc patent protected medication, unless theres a generic version which chemist & prescriber can vend with patient consent.

[skissane]

> The waiting for the patent to expire

That's not what the Australian government does.

Even for prescription drugs still under patent, the federal government negotiating on behalf of the whole country as a monopsony purchaser can demand (and get) much bigger discounts. (A monopoly is when a market effectively has only one seller, a monopsony is when a market effectively has only one buyer.)

Whereas, in the US, each insurer negotiates separately, so all but the very largest have weaker bargaining power than the Australian government has, simply because they don't represent as many insureds. The US has over 1000 health insurers, only the top two or three (such as UnitedHealth Group) have more insureds than the Australian government has (26 million).

Plus, even though a handful of very large US insurers such as UnitedHealth have more insureds than the Australian government does, the fact that the Australian government is a sovereign state and not just the purchaser but also the regulator and legislator gives it additional negotiating clout that such private insurers lack. Also, if UnitedHealth refuses to reach a deal with the drug manufacturer, they risk losing insurance customers to other insurers who are willing to do so; Australians can't realistically switch public health insurers (moving overseas is the only real way; private health insurance usually has very modest prescription drug benefits)

> Australia would have to start funding research.

Australia actually does have significant medical research funding. Unfortunately it seems to be a struggle to find good data on exactly how much (in easily comparable terms, such as %GDP) – the WHO's statistics [0] on this topic are missing both the US and Australia for whatever reason. But even in the absence of hard figures, I'd totally believe the US spends at least double (on a % GDP basis). But I think that's part of a broader economic problem with Australian underspending on R&D (both public and private) which goes beyond just health.

The other problem I know, is Australia has largely lost its ability to productise pharmaceutical innovations (outside of certain niche areas), which means even when some novel drug is discovered in Australia, they need to turn to to a US or European company to turn it into a product. But that's more a consequence of poor industrial policy (most of Australia's pharmaceutical manufacturing sector moved overseas, and what's left is mostly lower-end stuff like vitamins and herbal supplements, with rare exceptions such as CSL) than anything to do with drug pricing.

[0] https://www.who.int/observatories/global-observatory-on-heal...

[robertlagrant]

> But I think that's part of a broader economic problem with Australian underspending on R&D (both public and private) which goes beyond just health.

That doesn't matter to this point. What matters is the US pays for the R&D that Australia gets to benefit from. You can stop R&D and drive down prices, as long as you're comfortable making world drug discovery grind to a halt.