in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.

in that case, you don't care if you drug cost 10€ or 2000€ because you aren't spending a single € from your own wallet, at least if you don't factor in taxes.

Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.

I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.

Is it the proof that a true unregulated free market doesn't work ? if left unsupervised, big companies are going to buy smaller companies until they are monopoly or make secret, behind the door, deal to keep price up.

It's what the USA is made on, the idea of freedom and free market. i believe the idea of unregulated market is more recent, think the 70's, but surely in the 50 years since then american would have pushed back against it and not elected people like Trump who are all in.

> I would think that americans would be much more vigilant about what medication they take

This is why I always check to make sure it's fiscally responsible before I start chemotherapy, or before buying that emergency inhaler for asthma, or before accepting paralytics and anesthesia when undergoing surgery. How fortunate that in America diabetics have the freedom to die rather than take overpriced insulin. Let the free market decide which child with leukemia deserves a bone marrow transplant and which deserves a casket! That's a much more responsible market than just having everybody chip in a small amount so that nobody needs to worry about the cost of the medications they need to live. Sure, in America millions will die or be bankrupted by healthcare costs every year, but that's better than spending a single $ from your own wallet if even a tiny fraction of it might help pay for someone else's medications right?

> Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get it paid by their own insurance but it cost them directly a lot of money.

That's the idea, but in practice there are so many layers of indirect government incentives, disincentives, and direct interventions that market is no longer effective for this purpose.

It's virtually impossible to find out how much a medical procedure actually costs. Most hospitals and clinics refuse to even estimate as a policy, which has led to the creation of things like pre-paid services for labor and delivery. Those are quite rare.

I'm 100% in favor of allowing the market to work - but at this point, we have the worst of both worlds and the best of neither. Either extreme would be better than what we have.

> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing.

> Is it the proof that a true unregulated free market doesn't work ?

The market is heavily regulated (frequently crazily) by the FDA, and the actual amount anything costs is heavily obscured from the eyes of any consumers by the fog of bureaucracy and insurance.

Many people have 3-4 tiers of fixed copays that the insurance company makes up - some pharmacies won't even tell you when there is a cash price or a "coupon" that would be cheaper than your insurance copay! And pharmacies don't publish a plain list of what the cash prices are, and it would be hard for most people to even produce the tier formulary, it's buried as a PDF in some obscure page of a horrible website. So we just go to the pharmacy and see what it'll cost us.

Also, one major insurer owns a major pharmacy benefits manager and one of the big 2 pharmacy chains, so they use that to put their thumb on the scale however they can, while the other insurers and PBMs play games to lock consumers into restrictive exclusive deals that are to their detriment.

Anyway we don't have a market at all when it comes to healthcare, because the majority of price information is withheld from consumers until the opportunity to make any choice, if it even existed, is well past.

The funny thing is that when you have one big customer (a country) - you get good prices.

When you have 30 insurance companies, 10000 companies buying insurance policies and millions of individuals - you get shit prices.

That's why the drug in question is 200 USD in US (after deductions) and 20 in Europe (including taxes).

Americans pay multiples more per capita, and receive worse healthcare based on outcomes compared to European nations. The UK on average has better oral health than the USA, but Americans love to joke about British teeth... I think the US believes it's own "free market" propaganda too much. Clearly socialised universal healthcare (which every G20 nation does outside the US) is a better system.

It does not work that way, though, because as a practical matter, the majority of routine medications in the US are generics now and quite cheap, maybe $25 out of pocket (and frequently zero) with even basic insurance. The crazy prices happen for the edge cases. Things that happen often enough that you may know someone affected by it, but are still a minority of most people's experience.

Part of the problem is that the way our healthcare system is setup, it's not even a remotely free market. It's pretty much a worst of all worlds situation.

> I would think that americans would be much more vigilant about what medication they take, the price it cost, and so would have much lower pricing. That's just how free market work, and technically there are many medication manufacturer and many customer.

(Not american) This assumes they have a choice, no? Do these medications have real alternatives?

> in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money.

Europe is a big place, buddy. Which particular part are "we" from today?

NHS England has NICE (National Institute for Health and Care Excellence), which does the cost-benefit analysis for all medicines prescribed, nationally. It frequently decides medicines aren't worth the money. If you, as a private citizen, want that particular medicine, you can waste your own money on it. NHS England does not have a moral hazard problem.

The NHS also spends money trying to convince people to exercise, eat well, lose weight, not smoke, look for early signs of cancer, etc., because they find that relatively tiny amounts of money on these campaigns results in massive, massive savings from not having to treat so much preventable disease later in life.

i think healthcare is one market where capitalism just doesn't work well at all. for those areas, it actually makes sense to introduce hard or soft price ceilings.

> Contrary to the USA where it's a much more responsible market,

This is satire? I can’t tell anymore.

I mean the USA is the only country where someone can allegedly murder a healthcare executive for denying treatment and popular culture is engaged in drooling about how well the alleged killer fills out a tailored shirt.