Home
/
RELIGION & LIBERTY ONLINE
/
Why cheap drugs from Canada won’t reduce U.S. Drug prices
Why cheap drugs from Canada won’t reduce U.S. Drug prices
Dec 8, 2025 10:23 PM

If you suffer from acid reflux, your doctor may prescribe Nexium. But at $9 a pill, the price is enough to give you a worse case of heartburn.

That’s the lowest price in the U.S. If you live in Canada, though, you can get the drug for less than a $1 a pill.

This price disparity leads many politicians to think the solution is obvious: Americans should just buy drugs from Canada or other countries where they are cheaper.

Its plan supported by economic liberals like President Trump and Bernie Sanders. Several years ago Sen. Amy Klobuchar (D-Minn.) and John McCain (R-Az.) twice introduced legislation to allow Americans to order up to a 90-day supply of medicines from a licensed Canadian pharmacy. The Democratic Party even made it a part of their party platform in 2016.

If this seems too easy, it’s because it’s an economically ignorant idea. Writing in the Harvard Business Review a few years ago, Rafi Mohammed explained why this strategy won’t work:

The reason why pharmaceutical prices are relatively high in the U.S. is panies employ mon strategy called differential pricing. This strategy targets specific segments with different prices. So instead of having the same price for everyone, the goal is to tailor the “right” price to various segments. Movie theaters, for instance, use differential pricing by offering lower prices to students and seniors. The assumption is students and seniors are sensitive to price, sooffering targeted discounts to them is profitable. As a result, moviegoers seated next to each other often have paid different prices.

For differential pricing to be profitable, targeted segments have to be easily identifiable, and,most importantly, arbitrage cannot occur. By arbitrage, I mean those who receive discounts don’t resell to customers who are currently paying more. This strategy works well at cinemas: it’s easy to identify seniors/students, and since tickets are sold individually at the door, enterprising seniors/students typically aren’t reselling discounted tickets for a profit.

Why are drug prices so much higher in the U.S.? The answer is straightforward: most countries regulate prices or have a single-payer health care system, in which the government pays for citizens’ health care costs. In a single-payer system, the government buys all a country’s pharmaceuticals, and it has leverage in “take it or leave it” negotiations with panies.

Mohammed’s explanation is helpful, but it’s also plete. What he doesn’t mention is the reason whythe price differential for drugs can work: because expensive medicines in the U.S. subsidize the creation of drugs for the entire world.

According to the pharmaceutical giant Eli Lilly, the average cost to discover and develop a new drug is between $800 million to $1.2 billion, and the average length of time from discovery to patient is 10 to 15 years.

If a product costs $1 billion to produce and bring to market, that is the initial fixed cost. Think of it this way: the initial cost to produce the very first Nexium pill is roughly $1 billion. But once that first pill is created, the cost to produce the second, third, fourth, . . . hundred thousandth pill is very low. But if the initial fixed cost cannot be recovered, then pany will lay out the money and spend a decade or more creating the product. New medications will simply not exist.

This point should be obvious—and yet it is widely overlooked and ignored. People see a drug, like Nexium, and forget that it only exists because a pany believed it could recoup the cost of research and development and make a profit by selling the medicine. But how is pany able to earn back the initial billion dollar fixed costs? By charging some buyer—whether a government, HMO, pany or individual—a price that will cover the initial fixed costs.

Once that fixed costs of creating the drug is covered, though, the price can be reduced since the remaining variable costs (e.g., the cost to produce each individual pill) tend to be relatively low. And this brings us to why you, as an American, pay a higher price for a drug that Canadians and Europeans get much cheaper.

To make it easier to understand, let’s imagine that a medicine is created to cure a single disease in three patients living in America, Canada, and France. Now let’s say that the patient in America pays all of the fixed cost ($1 billion), plus the variable cost for one pill (50 cents), plus 50 cents in profit for pany. In total, the American ends up paying $1,000,000,001 for a single pill.

The pany is happy because they recouped their costs and made a profit (50 cents). Canada and France say that they too want to buy the drug, but they will pay only $1. The pany agrees to sell the pill for $1 to both Canada and France because an additional $1 profit is better than $0 in additional profit. Everyone is happy.

Well, maybe not everyone. The American may say that it wasn’t fair for them to pay all the fixed costs —and they’d be right. In our example, Canada and France are free riders that are able to take advantage of the lower costs only because the Americans have already paid the exorbitant fixed costs. The American subsidized the cost of the drug for the patients in the other countries.

This is exactly what happens with most drugs. Very few new medicines are produced in countries that have government restrictions on drug prices. And almost no new drugs would be produced if all countries had government restrictions on drug prices. Without the willingness of the United States to pay the higher prices, the drugs would never e into existence. Countries like Canada and France are like roommates who let you pay full price for a pizza but expect you to give them a slice in exchange for a few pennies they found in the couch.

Which brings us back to the “reimport the drugs” strategy. The reason this approach won’t work is because once Americans stop subsidizing the drugs for the rest of the world, panies will not be able to recoup their costs for R&D. paniessimply won’t be able to afford to create innovative new medicines. That makes everyone worse off than before.

Ultimately, socialized medicine—in the form of government-imposed drug pricing—doesn’t work for the same reason Margaret Thatcher said socialist governments don’t work: “They always run out of other people’s money.”

Comments
Welcome to mreligion comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
RELIGION & LIBERTY ONLINE
How Conservatives Fight Poverty
At Public Discourse, Ryan T. Anderson reviews Lawrence Mead’s From Prophecy to Charity: How to Help the Poor: The loudest voices in our national debates about political economy tend to be libertarians and social welfare statists. To our detriment, most public policy discussions are filtered through these two lenses. At the same time, we tend to conflate the policy issues facing our nation as if they were one and the same. But consider the range of America’s political-economic challenges: How...
Creeping Crony Corporatism
In this week’s Acton Commentary, “Corrupted Capitalism and the Housing Crisis,” I contend we need to add some categories to our thinking about political economy. In this case, the idea of “corporatism” helps understand a good deal of what we see in the American system today. Adding corporatism to our quiver helps us to make some more nuanced distinctions than simple “socialism” and “capitalism” allow. Take, for instance, Mitt Romney’s contention this week while campaigning in Michigan that the bailouts...
Gleaner Tech #1: Solar Bottle Lights in the Philippines
[Note: This is the first in an occasional series on gleaner technology.] In the Philippines, the cost of electricity often means poor citizens are left in the dark—even when the sun is shining. Social entrepreneur Illac Diaz e up with an indigenous and ingenious solution for lighting problems in the country’s e areas: He use plastic bottles, water, and chlorine to lighten up the dark homes of poor. The solution provides both a cheap source of lighting and environmentally friendly...
Befuddled Bureaucrats on the Bayou
I’ve tried to stay on top of the federal government’s response to natural disasters here at Acton. I’ve written a number mentaries, blog posts, and a story in Religion & Liberty covering the issue. “Spiritual Labor and the Big Spill” specifically addressed the 2010 Gulf of Mexico oil spill. For extensive background on this short clip of Bobby Jindal at CPAC 2012, see my post “Bobby Jindal on Centralized Disaster Response.” ...
Welcome to the PowerBlog, Joe Carter
When we launched the PowerBlog in 2005, we had little idea that it would grow into one of the Acton Institute’s most popular and munications channels. Nearly 4,000 posts, and ments later, the PowerBlog is still going strong. And for that, we heartily thank our many readers, contributors menters. Now we have for the first time a dedicated editor to help sustain and grow the blog for the advancement of the “free and virtuous society.” Veteran journalist Joe Carter is...
Subsidiarity vs. Soft Totalitarianism
While the recent contraceptive mandate controversy has exposed the Obama Administration’s disregard for religious freedoms, it has also reveled their natural disdain for subsidiarity. As George Weigel notes, this incident tells us “something very important, and very disturbing, about the cast of mind in the Executive Branch.” It is no exaggeration to describe that cast of mind as “soft totalitarianism”: an effort to eliminate the vital role in health care, education and social service played by the institutions of civil...
Politicians and the Pursuit of Happiness
In this week’s Acton Commentary I conclude, “The American people do not need politicians to tell them what happiness is and how it should be pursued.” I admit that I didn’t have this quote in mind (or I would have used it!), but Art Carden (follow him here and read him here) notes the following from Adam Smith’s Wealth of Nations: What is the species of domestic industry which his capital can employ, and of which the produce is likely...
The End of Secularism and the HHS Mandate
The primary point of my first book, The End of Secularism, was to demonstrate that secularism doesn’t do what it claims to do, which is to solve the problem of religious difference. As I look at the administration’s attempt to mandate that religious employers pay for contraceptive products, I see that they have confirmed one of my charges in the book. I wrote that secularists claim that they are occupying a neutral position in the public square, but in reality...
The “Right to Be Insured” Trumps Religious Liberty?
New York pundit Al Sharpton and California Senator Barbara Boxer agree: The “right” to insurance paid for by an employer trumps freedom of conscience and religion. Senator Boxer warned yesterday that if the HHS contraception mandate was repealed it would set a dangerous precedence of religious rights trumping the right to be insured. On MSNBC’s Politics Nation with Al Sharpton last night, Boxer affirmed that under the proposed amendment proposed by Sen. Roy Blunt, an employer would not be forced...
Gleaner Technology
Gleaning is the traditional Biblical practice of gathering crops that would otherwise be left in the fields to rot, or be plowed under after harvest. The biblical mandate for the es from Deuteronomy 24:19, When you reap your harvest in your field and forget a sheaf in the field, you shall not go back to get it. It shall be for the sojourner, the fatherless, and the widow, that the LORD your God may bless you in all the work...
Related Classification
Copyright 2023-2025 - www.mreligion.com All Rights Reserved