I appreciate this submission; it's a story that challenges a number of my views, which I think are relatively common around HN. Broadly, I've thought that high

I appreciate this submission; it's a story that challenges a number of my views, which I think are relatively common around HN. Broadly, I've thought that high drug prices in the US stem from a mix of our bizarre insurance system (which rewards 'ambitious' pricing) and regulation. For name-brand drugs, that's largely patent protections, but even for generics it happens via process patents, high filing-fee barriers to enter markets, and regulatory delays to start production. (See e.g. here: https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-healthcaristan-ssr/ https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-...) I still believe those things are issues. But this story has pushed me to revise how much I think those things matter relative to outright price manipulation. And if the answer is (as I suspect) that clumsy regulation raises costs some everywhere, but gouging raises costs massively for some drugs, then the question of how to fight both problems at once is exceedingly difficult. The only way to escape these sorts of tradeoffs is usually "make better regulations", and it's not clear how we make that happen.