Yes, a lot of people don't understand the sheer amount of labor and time that is required to bring a new drug to market. (Edit: Or the number of things that are tried but don't pan out for one reason or another. The success rate is very low.) I myself have only the vaguest understanding. Someone has to pay for it all.

We need India to get rich ASAP, so Indians can start paying for it. :-)

Surprise, surprise but a huge chunk (maybe even the majority of?) of drug research is conducted by academic institutions using government funded grants. Then the drug companies come swoop up the research, refine it, mass produce, and market. They shouldn't be able to get such a free ride from all this government funded research imo. The taxpayers already funded the research so why are they getting the short end of the stick?

Research is the least labour- and time-intensive part of the system.

Trials are punishingly expensive.

Edit: protocol development. Drug interactions. Poisonings, Doctor education -- er, marketing. Incorporation into manuals. There's a lot that happens after the research talent has strutted its stuff.

Edit edit: oh, yeah developing manufacturing and logistics as well. The 'D' part of "R & D" is usually over 95% of the total for a reason.

The challenge is that Pharma companies still spend huge sums on marketing, both to patients and to doctors. While I could probably be convinced that there's some role for spend on physician education about new drugs or spreading awareness, it should be a small fraction of the spend on R&D and manufacturing.

https://www.raps.org/news-and-articles/news-articles/2019/7/...

So the cheap part is government funded but the expensive and risky part is private and you take that as them getting a "free ride".

If the capitalistic system doesn’t produce results, we can do like India and have state-funded drug R&D and so on.

https://en.wikipedia.org/wiki/Ormeloxifene

Frankly this system is already deep into market failure in the US and should be reformed anyway. We are not getting important drugs approved here because they can’t make it through approval despite track records of safe and efficacious use in hundreds of millions of people. That’s an intense life-wasting market failure.