> The real reason why European countries (and Canada) pay less is because they legislate discounts. They give the drug companies no other options. I would call it arm-twisting more than negotiating.
What do you mean by 'legislate discounts'. As far as I'm aware, most European countries do not get involved with compulsory licensing, which is what it seems you're referring to.
I suspect the difference is more about public relations - an insurance company does not want to get in the news for turning down a particular treatment, because people will move to another company. With a public system, you are spending taxpayer money, so there's more of an acceptance of a balance between cost and benefit, and therefore the buyer has some credibility when they say they will not pay above the level of cost-effectiveness.
What do you mean by 'legislate discounts'. As far as I'm aware, most European countries do not get involved with compulsory licensing, which is what it seems you're referring to.
I suspect the difference is more about public relations - an insurance company does not want to get in the news for turning down a particular treatment, because people will move to another company. With a public system, you are spending taxpayer money, so there's more of an acceptance of a balance between cost and benefit, and therefore the buyer has some credibility when they say they will not pay above the level of cost-effectiveness.