That’s what happens if you don’t have public health care.

A small insurer or even an uninsured person cannot bargain with large pharma companies. If they try to, the pharma company will just not sell the product, because it’s more expensive for them to lower the prices for everyone compared to losing one small customer.

But if your whole country’s health system bargains at once, it can get much better deals, because not taking a deal means for the pharma company that they’ll lose access to millions of potential customers.

That’s why for example in Europe Insulin costs about 10% per dose compared to what people in the USA have to pay.