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 21, 2025 7:59 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
Health Care Subsidiarity in the UK and the US
A recent New York Times story reports that the new British government plans to “decentralize” the National Health Care system as part of its new austerity measures. Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use...
Ralph Raico on Religion, Lord Acton, and Classical Liberalism
One of the charges sometimes leveled against classical liberal thought is thatit opposes all authority; that it seeks toreduce society to an amalgamation of atomized individuals, eliminating the role of munity, and vibrant social institutions. Historian Ralph Raico seeks to argue the very opposite in his dissertation, The Place of Religion in the Liberal Philosophy of Constant, Tocqueville, and Lord Acton.The work has been republished for the first time by the Mises Institute. (A particularly interesting note is that the...
Manuel F. Ayau (1925-2010): A Life for Liberty, Justice, and the Truth
Those who love freedom were saddened to learn this morning of the passing of one of the most significant contributors to the cause of liberty and individual responsibility in Latin America, Manuel F. Ayau, affectionately known as “Muso” to his many friends and acquaintances, after a long and brave struggle with cancer. A humble, self-effacing but determined man, Ayau is a classic example of someone who made a difference. Whereas others confined themselves to talking about the free society, Ayau...
Europe’s Surviving Farmers Show True Entrepreneurial Spirit
Are the Old Continent’s farmers showing that they have a real entrepreneurial spirit and serving as role models of courage and innovation during the Great Recession? Surely not all of them, but there are some inspiring examples to be found in Central and Southern Europe. This is somewhat surprising as Europe’s agricultural sector is usually among the most traditional, least open to market innovation and product flexibility, and heavily reliant on EU funding to keep the petitive. Alas, European leadership...
Salary and Significance
During a recent conversation, a Chinese friend of mented on the lack of political involvement that she has observed in her peers, especially parison to American college students. She attributes this lack of involvement to the fact that the Chinese do not believe that political action can change the policies or even the identities of their leaders. As a result, non-politicians in China do not get involved in politics, and politicians there focus on achieving their own goals rather than...
Rome’s Graffiti and Bastiat’s Broken Windows
Today’s Wall Street Journal has a nice piece about the problem of graffiti in Rome and the obstacles to cleaning it all up. While the graffiti are certainly an eyesore in an otherwise beautiful city, there is also great economic damage done, which leads to impoverished understandings of private property and general urban decay. If cleaning up the graffiti on a four-story palazzo can cost as much as €40,000, there are surely people there to profit from the clean-up. And...
Chinese Politics: Power, Ideology, and the Limits of Pragmatism
Chinese Communism is no longer about ideology. Now it is about power. I reached this conclusion on the basis of six months spent in China and extensive conversations with my Chinese friend and fellow Acton intern Liping, whose analysis has helped me greatly in writing this post. China began moving away from Communist ideology under Deng Xiaoping, whose economic reforms munes and created space for private businesses. He justified these reforms to his Communist colleagues with the saying, “It doesn’t...
Re: Broken Windows – University Funding Edition
As Kishore Jayabalan noted yesterday, the fallacy of “broken windows” is, unfortunately, ubiquitous in discussions of public finance and macroeconomics. Though we are told that government spending and public works have a stimulating effect on economic activity, rarely are the costs of such projects discussed. Such is the case with several stimulus projects in my own hometown of Atlanta, GA. The Atlanta Journal-Constitution reportson a list that Sen. John McCain and Sen. Tim Coburn drew up,criticizing wasteful stimulus projects throughout...
Here I Stand: Marketing and Remembering the Reformation
I just couldn’t pass this one up. Below is an ENI story on the installation of 800 “colourful miniature figures of the 16th-century Protestant Reformer Martin Luther” in the market square of Wittenberg. Just as last year there was a good deal of academic mercial interest around the 500th anniversary of the birth of John Calvin, you can expect a great deal of activity leading up to the 500th anniversary of the traditional date of the dawn of the Reformation...
An Open Letter from Alexis de Tocqueville to President Barack Obama and the American People
I think that the oppression threatening democracies will not be like anything there has been in the world before…. I see an innumerable crowd of men, all alike and equal, turned in upon themselves in a restless search for those petty, vulgar pleasures with which they fill their souls…. Above these men stands an immense and protective power which alone is responsible for looking after their enjoyments and watching over their destiny. It is absolute, meticulous, ordered, provident, and kindly...
Related Classification
Copyright 2023-2025 - www.mreligion.com All Rights Reserved