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Why are US drug prices getting much higher?为什么美国药品价格越来越高?

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Rick VonderBrinkWhy does the US let drug makers set their own drug prices? Does this lead to higher drug prices here in the US?We let drug makers set their own prices because this is a free market economy.Tonight you will be hungry. There are three restaurants close to your house: Morton’s of Chicago steakhouse, Outback Steakhouse, and McDonald’s.At Morton’s you will get a prime cut of meat, aged for 30 days, cooked to order by a highly trained cook, paired with a fine wine, and served with delicious side dishes by highly attentive wait staff. You will also pay over $100 for your meal.At Outback, you will get a distinctly lower quality cut of meat, aged since this morning, served with Coors Light . You will pay around $30.At McDonald’s, you will get the world’s most generic hamburger, fries, and a Coke, served by a teenager who’d rather be checking his phone than listening to you. You will pay $5, maybe less if you order from the value menu.Not that in each case, when you walk away, you will not be hungry and your body will have obtained nourishment. But the experience was vastly better when you spent more.为什么美国让制药商自行制定药品价格？这会导致美国药品价格上涨吗？我们让制药商自行定价，因为这是自由市场经济。今晚你会饿的。你家附近有三家餐厅：芝加哥莫顿牛排馆、澳洲乡村牛排馆和麦当劳。在芝加哥莫顿牛排店，你会得到一块上等的肉，陈化30天，由训练有素的厨师烹制，配以美酒，并由细心的服务员提供美味的配菜。你还将支付超过100美元的餐费。在澳洲乡村牛排馆，你会得到一块质量明显较低的肉，从今天早上开始陈化，配上银子弹啤酒。你将支付大约30美元。在麦当劳，你会得到世界上最普通的汉堡、薯条和一杯可乐，由一个宁愿看手机也不愿听你说话的青少年提供。你将支付5美元，如果你点超值菜单，可能还会少点。并非每个案例都是如此，当你离开时，你都不会饿，你的身体也会得到营养。但如果你花的钱越多，体验就会好得多。

Maybe you can’t afford to eat at the high-end steakhouse, or maybe you’d like to do it more often. You think it isn’t fair that it is that expensive. You get your local congressman to agree, and a law is passed capping the price of a meal at a restaurant at $20. You triumphantly show up at Morton’s with your $20 bill and prepare yourself for bliss.Guess what happens? You no longer get a 24 oz cut of aged prime New York strip, because that is too expensive. The steak you do get is no longer cooked to order, the wait staff is less attentive, and the wine list consists of Two Buck Chuck. It isn’t a great experience, and you might not go back. Or you might not get the chance to, as they are likely to go out of business, because they can no longer afford their rent.You try Outback instead, but even their food is worse. The steak is smaller and the Bloomin’ Onion is gone.McDonald’s is unaffected, because their meal never did cost more than $20.也许你没钱去高级牛排馆吃饭，或者你想经常去，你认为这么贵是不公平的。你让当地的国会议员同意，然后通过一项法律，将餐馆一顿饭的价格限制在20美元。你得意洋洋地出现在莫顿餐厅，手里拿着20美元，准备迎接幸福。猜猜会发生什么？在纽约黄金地带，你再也买不到一份24盎司的陈年干酪，因为那太贵了。你吃到的牛排不再是随叫随到的，服务员也不那么细心了，酒单上只有廉价红酒“两元恰克”。这不是一次很好的经历，你可能再也不会去了。或者你可能没有机会了，因为他们很可能会破产，因为他们再也付不起房租了。你可以试试澳洲乡村牛排馆，但就连他们的食物也更糟糕。牛排变小了，洋葱也没了。麦当劳没有受到影响，因为他们的餐费一直就没有超过20美元。

This is essentially the drug market. There is always McDonald’s. There are many conditions I can treat effectively with cheap generic drugs. I have many patients who are on half a dozen meds and don’t pay more than $10 per month for any of them. These are mostly older meds that are nevertheless still effective. If it works, great.However, we like medical progress. There are things I can treat better and more effectively now than I could 20 years ago. Innovation is expensive. Developing a new drug can cost hundreds of millions of dollars and take 10 years. Sometimes that time and money go to waste because the drug is rejected by the FDA over safety concerns (most new drugs do not make it through this process). Drug companies are not going to take the risk of making new drugs unless there is a reward at the end of the tunnel, and that reward is the profits from the initially very high prices. They get those profits primarily from the US market. Congratulations America, you fund drug development for the whole world.But if you limit those profits with price controls, there is less risk taking, less development, and less progress. A diabetic that I treat with nothing but generic drugs is going to do much worse and die sooner than one I treat with the fancy new stuff.Yes, it sucks if you are the one spending $$$ on meds. The meal at Morton’s was expensive, but you wanted to go there, enjoyed the meal, and will remember it fondly. Absolutely no one wants to spend $100 on medications. But not dying or losing your vision or having crippling arthritis is good too.这就是药品市场。那里总是有麦当劳。我可以用便宜的仿制药有效地治疗许多疾病。我有很多病人同时服用六种药物，每个月的药费都不超过10美元。这些大多是老药，但仍然有效。如果有效，那就太好了。然而，我们喜欢医学的进步。与20年前相比，我现在可以更有效地治疗一些疾病。创新是昂贵的，开发一种新药可能要花费数亿美元，耗时10年。有时，这些时间和金钱会被浪费，因为该药物因安全问题被美国食品药品监督管理局拒绝（大多数新药都无法通过这一过程）。制药公司是不会冒险研发新药的，除非在研发过程的尽头有回报，而这个回报就是从最初的高价格中获得的利润。他们的利润主要来自美国市场。祝贺美国，你们资助了全世界的药物研发。但是，如果你用价格控制来限制这些利润，就不会承担那么多的风险，就会减少发展，也会减少进步。我只用非专利药物治疗的糖尿病患者会比我用新奇的药物治疗的糖尿病患者更糟糕，死得更快。是的，如果你是那个花钱买药的人，那就太糟糕了。这就像在莫顿餐厅吃的饭很贵，但你想去那里吃，吃得很好，会留下美好的回忆。绝对没有人愿意在药物上花费100美元，但不死亡、不失明、不患致残性关节炎也是好事不是。

Maureen BoehmWhy are prescxtion drug prices so high in the U.S. compared to the rest of the world?Because we let them.Read that again.Because WE let them.Medicare Part D specifically PROHIBITS the negotiation of drug prices.(Some Big Pharma lobbyist, somewhere, broke out the champagne and got a huge bonus for that one.)Just about every other country in the world, where universal health care exists, negotiates their drug costs. Those countries know that saying that the system pays only X dollars for Y drug means that effectively, that drug won’t go anyone in that country, unless Big Pharma plays ball.The same cancer drugs that cost thousands here can be purchased in Europe for one hundred dollars.为什么美国的处方药价格比世界其他地方高?因为我们让他们这样的。再读一遍。因为“我们”让他们这样的。医疗保险D部分特别禁止就药品价格进行谈判。(在某个地方，一些大型制药公司的说客打开了香槟，并因此获得了巨额奖金。)世界上几乎所有其他存在全民医疗保健的国家都在协商药品成本。这些国家知道，说系统为Y种药物只支付X美元的话，实际上意味着，除非大型制药公司合作，否则这种药物不会进入该国的任何人手中。同样的抗癌药物在美国要花几千美元，在欧洲只要100美元就能买到。

I have a friend, with type 1 diabetes who rations her insulin because she can’t afford the five hundred dollar cost, each month. Without insulin, she will die.I have another that can no longer pay for the rheumatoid arthritis drug, that keeps her functional, because her insurance company won’t pay the four thousand dollars a month for Enbril. It is an older drug. It used to cost seven hundred a month.My son has severe allergies. He used to carry an Epi-pen with him everywhere. Again, a very old drug. Used to cost ninety buck for two. It went up to around eight hundred each.Why?Because WE let them.Who is WE?It’s YOU and ME.If we don’t take action, we will continue to be like sheep going to the slaughter house.The sheep aren’t doing anything about because, well, they’re sheep.Don't be a sheep.我有一个患有1型糖尿病的朋友，她需要定量使用胰岛素，因为她负担不起每月500美元的费用。没有胰岛素，她会死的。我还有一个无法再支付治疗类风湿性关节炎药物的费用，因为她的保险公司不会支付每月4000美元的Enbril费用。它是一种较老的药物。过去一个月要花700美元。我儿子有严重的过敏症。他以前到哪都带着肾上腺素注射器，这又是一种非常古老的药物。以前两支要90美元，如今每支价格涨到了800美元左右。为什么？因为我们让他们这样干的。我们是谁？是你和我。如果我们不采取行动，我们将继续像羊一样走向屠宰场。绵羊什么也不做，因为，它们是绵羊。不要做绵羊了。

You have the power to vote. You have the power to protest.There is currently drugs cost legislation being considered, in Washington.If you are interested, and it’s cool if you are not (bah), go to FightPharma.org/senate.There you can send a letter to the senators involved in this decision.Tell your story. Add personal comments.Let them know that this is an issue that will determine your vote, when they come up for re-election.你有投票的权力、你有抗议的权力。目前，华盛顿正在考虑就药品成本立法。如果你感兴趣，如果你不感兴趣也没关系，请访问FightPharma.org/senate。在那里你可以写信给参与这个决定的参议员。讲述你的故事，添加个人评论。让他们知道，当他们竞选连任时，这个问题将决定是否获得选票。

It took me fewer than five minutes.As I uncover more practical steps that you can take, I’ll let all my wonderful Quora followers know.Peace.Edit——Anyone that wants to throw blame around in the comments can stop right here.The point of this answer was to empower and inform, not to bash each other’s political points of view or to throw blame around.The house is burning down, arguing about who should put it out is a waste of time.我只用了不到五分钟的时间。当我发现更多你可以采取的实际步骤时，我会让我所有优秀的Quora粉丝知道。和平编辑----任何想在评论中指责别人的人都可以在这里停下来。这个回答的重点是赋予权力和信息，而不是抨击彼此的政治观点或相互指责。房子着火了，争论谁来灭火是浪费时间的行为。