It's true that the US pours a lot more money into drug R&D, and I understand that a lot of push for more global + stronger patent law comes from pharmaceuticals. However, when medicines change owners, and then get 10x price hikes years after being developed (like EpiPens, or Generics that get a tweak + a new patent), the problem is not just repaying for the R&D.

The more serious problem, is that reforming the machine that is the US health care industry is going to cost a LOT of jobs. That is going to make any kind of meaningful reform very difficult.