What? I'm not talking about that at all. I'm saying that most papers are already available to everybody who wants them, whether they're from the US, Hungary or Botswana (as long as they have an internet connection and basic research skills).

No. No, they're not. Unless the field in question has open archives like arxiv.org, and medicine (to take one at not-so-random) does not - or at least didn't until the NIH started doing the right thing. This has always been perceived - rightly or wrongly, but I suspect there's a lot to it - as one more way America oppresses the little guy. Or in this case, the little country.

Unfortunately, I would wager a guess that most of the money is in these large, rich countries. There is little incentive for Elsevier et al to lower prices when they can demand top dollar from American and European universities.