I don’t think it is BECAUSE we spend more on healthcare, but DESPITE our spending more that many of our countrymen/women are destined to die prematurely.

Don't overlook that we just pay more as well. In the US, drug prices are controlled by pharmacy benefit managers (PBMs). In theory, PBMs negotiate drug prices for insurance companies. And they do. They also get rebates from the drug manufacturers in order for favorable place on insurance companies formularies. To offset the cost of these rebates, manufacturers raise the "list price" of their drugs. This practice is encouraged by PBMs because their profits are tied to the size of the rebates, which are larger for higher-priced drugs.

The industry is becoming integrated where the largest pharmacies have their own PBMs. This leads to odd effects for example, your co-pay for a particular drug with insurance costs you more at say, CVS, than than paying 100% out of pocket at an independent pharmacy.

Berkshire Hathaway FAQ

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