> Doesn’t that get back to if you got rid of marketing and let both the government negotiate drug prices (which it legally can’t do now) you could reduce prices and not spend less on research?

"Negotiate drug prices" is a monopsony buying from a monopoly. It's like divide by zero, there's no pricing mechanism there. This drug is already developed so if the government makes up a lowball price they have no real choice, but if the government offers them less then they cut research for new drugs because now it has a poor ROI. It's effectively price controls and government officials using a ouija board to make up drug prices when what you actually want is some kind of market to determine how much it's worth to people in order to supply that much incentive for developing drugs like that.

And a lot of countries do use price controls because then they still get the drug as long as the US market is picking up the tab to fund the R&D. But that doesn't work if everybody does it, so now the problem is the tragedy of the commons. The US is being cheated into shouldering the burden for the whole world, but if they stop without everyone else starting to pay their share then the research funding collapses, so what do you want to do?