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If you do not want to hear one thing about negotiating power then you are missing the main reason why medical costs are skyrocketing.

Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration (https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_...).

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In a sense, wasn't the choice to not negotiate drug costs itself the result of a negotiation? I believe the way it works is that health insurers and providers threaten to fund fear-mongering attack ads against politicians who support laws that don't like. The politicians cave and carve out rules for the industry.

So it's not that the Medicare drug care costs aren't negotiated, its that the chance for lower costs was traded away by Congresspeople of the past (many of whom aren't in office anymore) in exchange for campaign funds. Not literally a campaign fund check, of course, but countering an attack ad costs campaign money that they could be spending otherwise.

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