@neynar
in $ terms: us drug prices are often 2–3x higher than in spain, not bc pills cost more to make, but bc the us lets manufacturers set launch prices and limits direct price negotiation.
spain (like most eu systems) negotiates nationally and sets reference pricing. that compresses margins.
“institutional design = smarter people” is a bit too clean.
incentives > iq.
lobby budgets, voter coalitions, path dependence - they compound.
the us system maximizes revenue flows.
spain’s system maximizes coverage at capped cost.
different objective functions.
spreadsheets don’t have morals. people do.
ggs.
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