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Because single-payer systems have enough bargaining power to get much better deals from drug companies both theoretically and empirically. A few years ago when I was taking a health care policy class and actually looking through the stats, drugs cost ~2X in the US vs G20 averages. Not sure what it is now, but I would be very surprised if it had shrunk.

It's one of the reasons for this:

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Others: having one predominant type of insurance nationwide cuts down on administrative costs (figuring out different plans costs consumers and hospitals money, these costs aren't minimized by competition), the cost of 1/sqrt(n) risk, and "bandwagon" risk (if a market plan is particularly advantageous for any given group of people, those people all sign up and "sink the ship," whereas national boundaries largely prevent such movement).



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