In a socialized medicine system, someone else is making this choice for you. Medical costs (drugs, doctors' education and time, research costs, equipment) are unbounded, while resources are not (no matter what kind of insurance you have), so tradeoffs have to be made. ("What? My daughter is dying from an extremely rare disease and you're not having 1000 PhD researchers working on the cure?! You're spending the resources on curing breast cancer instead?!? WHAT IS WRONG WITH YOU!!!") AFAIK (though I haven't deeply researched this topic) society-level recommendations aren't made on what is best, but on what is most cost effective (e.g. how often you should have mammography, when you should start having regular colon cancer scans) so it's perfectly reasonable, if you're rich(er), to supplement the public medical system with some extra resources of your own to improve the health outcomes of yourself and/or people close to you. In addition, that funds new research (e.g. the anti-aging craze currently happening in SV, funded mostly by rich billionaires that don't want to die... the medical system doesn't even recognize aging as a disease (so drugs can't be approved to be "anti-aging")!)

One provider might charge a fortune. But then another will come along and realize he can get all this business by charging slightly less than a fortune. Then another comes along and charges slightly less. And so on until they are charging just enough to make a slight profit.

That’s how a healthy market works. But if you put up tons of barriers and rules about who can provide a service and how the service must be performed, the whole competitive system breaks down.

Would you prefer a shortage of food every few years?

For instance grain crops can be stored long-term by the government [1] and of course so can raisins [2]. None of this has to do with the farm bill.

[1] https://en.wikipedia.org/wiki/Strategic_grain_reserve

[2] https://en.wikipedia.org/wiki/National_Raisin_Reserve

Sorry, are you referring to proving that treatments have effect, doctors being licensed, something else?

Erm, no. Because if people can't pay for it, then your drug get no sales, and you lose your investment. The problem right now is that there are several payers involved and nobody sees the real cost of things. Were you to pay directly for drugs from your own pocket without intermediaries I'd wage all drugs would be way cheaper.

https://www.washingtonpost.com/health/uva-has-ruined-us-heal... (https://news.ycombinator.com/item?id=20921887)

There's a reason Sovaldi is $84,000 and it's not because it costs a lot to make. It's the same reason as soon as they realized that you could treat cancer with Thalidomide the price rose two orders of magnitude.

If you need something more than the seller needs your money they're free to adjust the price up no matter how many of them there are. For instance, a hurricane comes in to town. All of a sudden, every gas station is charging $50/bottle for water and $10/gal for gas, even though the market is no more or less competitive than the day before when they charged $2.50. Externalities matter. Gouging like this is illegal in the event of bad weather but it's the status quo in the event of bad health, and much of the time, you exert equal control over both. The only real difference is one tends to skew acute and the other tends to skew chronic, I guess.

in you price gouging example prices are high because demand is so much higher than supply, but goods still change hands.

again, this is all in theory

It's kind of easy for a country to dictate drug prices when they had no hand in developing them. Now show me a country like the US that develops just as many drugs. Ah, you can't, there is none.

More generally, while I know what you are getting at you have to be careful with this sort of statement "this is the only way to do the drug development" is a pharma industry talking point but it is largely bullshit (although not entirely, the model run in the US does make it quite expensive and that can't be fully supported the way it is on, say, generics pricing).

It is true that the US is more productive in this space per capita than most places (but not as much as many think) , but it is really difficult to determine if this is primarily due to fundamental capacity, or due to financial incentives...

https://www.evaluate.com/vantage/articles/data-insights/othe...

Edit: found a good source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

Note, per capita it looks like most of the countries studied are discovering new drugs (in the study's terminology "new molecular entity") at much faster rate than the United States when adjusted for population.

The money quote: " Our data suggest that the United States is important but not disproportionate in its contribution to pharmaceutical innovation. Interestingly, some countries with direct price control, profit control, or reference drug pricing appeared to innovate proportionally more than their contribution to the global GDP or prescription drug spending"

There's a reason it costs less in canada and the UK and it has nothing to do with R&D costs.

It comes down to this debate because the pro market people offer zero solutions other than staying the course and the course is straight down. Offer something better.

I don't understand why that matters. But if it does, couldn't the US implement social healthcare at the state level? Canada and California have roughly equal populations, for instance.

IMO, the federal government has been getting too large just like how they dangle interstate highway funds from states for enforcing the stupid 21 year old drinking age.

No state alone can, because it would have (or at least would fear) a large influx of people coming for the free healthcare. If enough states set up their own systems and make them interoperable, it might have some legs. I hear rumblings of this from time to time,

What I meant was a federally-mandated, state-implemented system. Federal law can define a minimum level of healthcare that every state is obligated to provide. States set up and administer their own systems, any way they want - single-payer, mandatory private insurance etc. Isn't that how Canada actually does it?

It handles the "US is too big" objection to universal healthcare that everyone loves to bring up, by moving the systems to a lower level.