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why wouldnamp;#39;t government Medicare why shouldnamp;#39;t they negotiate drug prices because this is something that a lot of people put forward including people some people in the Trump administration the problem is that when thereamp;#39;s a dominant single buyer itamp;#39;s an imbalance negotiation this is sort of like a monopoly but on the buy side monopsony if the negotiating pair is so dominant and secondly the negotiator whoamp;#39;s paying does the government does Medicare care if the cancer drug is not available compared to the guy with cancer well of course not thatamp;#39;s all part of the negotiation you have to have this so-called skin in the game itamp;#39;s very different for Matt for the insurance company this for an individual this is a bad situation for patients how do I know thatamp;#39;s a bad situation because the data shows that this gives less drug availability in the countries that do this and that translates into worse outcomes more people die