> Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? Pharmaceutical companies bribe

> Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? Pharmaceutical companies bribe—sorry, lobby—members of Congress so those members of Congress vote against letting Medicare negotiate pricing. Since money is speech, (see Citizens United v FEC) the one with the most money wins.