It’s counter intuitive but totally valid. Another angle on this would be to lower the standards for clinical trials. The fact that it costs billions of dollars to run a drug trial is a key part of why everything is so expensive the FDA standards are extremely high. The result is safe drugs but it also makes the R&D market extremely skewed towards the big entrenched players. There is also no room for physicians or patients to take calculated risks. Sure it all falls into a sensible self consistent philosophy of “do no harm” but the side effects of that principle are extreme cost and actually slow innovation. In this modern era data collection should not be this expensive.

We have continuously overcorrected in the hundred years since we banned snake oil medicines.

Sure, people should know what they are taking, and they should take things that are safely manufactured and safe to use.

But, there needs to be room for a person to make decisions as part of their body autonomy. I personally want to wait before taking peptides because they're so new, but people who see the initial results and want to be human guinea pigs should be allowed to.

There really needs to be a middle ground between a decade of testing on the off-chance that 1-in-1,000,000 parents gets an upset stomach, and ordering who-knows-what research chem from a sketchy website.

Phase 2 clinical trials establish safety. IMHO anything that passes phase 2 should be prescribable. Phase 3 is the expensive one.

Generally we should be lowering costs, but if lowering development costs results in more therapies, even if they're cheaper our aggregate cost trajectory could remain the same.

We're an incredibly rich society with a near universal ethos that cost should be no obstacle to life saving treatments, and by extension life prolonging treatments. Despite our many inequities we'll blow millions on treatments that extend life by 5 months. Sometimes (often?) we don't, and it gets roundly criticized as a moral failure, but nobody seriously suggests maybe our target standard of care should be something other than everything possible. (Ivory tower proposals abound but most of us regress to the mean when push comes to shove.) Examples of treatment unavailability that are scandalous here are the norm almost everywhere else, because countries carefully throttle the introduction of expensive therapies at their borders.

In this environment of course our healthcare costs will skyrocket, so long as there's a steady stream of marginally better therapies. We don't need fraud or corruption or misaligned incentives. Those things accelerate the situation and contribute to inequities, but the fundamental trajectory is just perfectly predictable and in a sense unfixable without either changing our shared ethos or fooling ourselves into rationing [future] care by sabotaging the pipeline of new therapies.

"Pace the frontier"

paying for GLP-1 is a net benefit to insurance pools, because obesity (and other uncontrolled hunger-like cravings) have very expensive downstream symptoms.

And yet, they still won't cover them for basically anyone

Which means they, who are in the literal business of doing math on these things, probably don't agree with the GP's assessment of "net benefit."