First, one thing to keep in mind: "Big Pharma" is the medical equivalent of "venture capital" in technology. They buy up a lot of patents and very early stage startups in the hope that 1 or 2 of 100 investments actually strike it big, and that explains a part of why new medical innovations cost so much - all the loss has to be distributed.

> It is a harrowing proposition: that in trying to control drug prices for 67 million Medicare patients now, we might inadvertently prevent the development of future drugs that could save lives. Implied, if not stated outright, is that we’re putting a cure for cancer or Alzheimer’s or some other intractable disease in jeopardy.

Well... given that a lot of the fundamental research in pharmaceuticals happens at universities and/or on taxpayer grants, what exactly is preventing the US government from taking over the later stages of development and the associated risk itself, and only use external providers for manufacturing at scale?

Of course, it's a rhetorical question. The answer is two-fold here - primarily the obvious: large parts of the US (and most Western nations facing similar questions) prefer a "small state", preferably as small as possible. But there's also a second answer... the US' very dark history in government-run medicine. The Tuskeegee syphilis study, the consistent discrimination against PoC and women in medical research, MKULTRA or the US just about permanently burning all of its trust across the world by using "vaccination drives" as a pretext to verify Bin Laden's presence in that compound in Pakistan [1] - antivaxxers, Covid deniers and their ilk didn't sprout up from nothing, they have very fertile soil.

[1] https://www.npr.org/2021/09/06/1034631928/the-cias-hunt-for-...