Universal healthcare providers sometimes choose to cover drugs or treatments that have slightly worse outcomes instead. The treatment that was state of the art 10 years ago probably still works just fine.

Patents last 20 years. But most of that time, a drug is in trials.

Providers can also choose not to cover other drugs by the same company, if they refuse to budge. Not being able to sell any drugs across an entire country would be a big problem for companies.

I thought generics were handled relatively similarly in the EU and the US, but apparently the US does grant a bunch of exclusivities, on top of patents.

However the biggest difference between those health systems still seems to be how providers bargain for lower prices.

In the US, insurances bargain for rebates. That means that if you buy a drug with insurance the insurance only pays a small percentage of the drug price. They are still allowed to demand copay on the list price. So often the insurance makes a profit in that transaction. But if you try to go around insurance you have to pay the full list price and will pay even more.

Over here, the universal healthcare providers bargain with the pharma companies to lower the list price. And with a much greater bargaining power to boot.

High prices are due to a lack of government regulations.

Pharma companies can set the prices according to what people are willing to pay. And people are willing to pay everything if it will save their lifes.

It doesn’t have to be. Here we have mandatory insurance. So it’s still called a premium.

I have, or well from other doctors at least. Our universal healthcare doesn’t pay things they don’t consider important. Paying everything would undermine their bargaining power.

But those bills are always itemized.