In an NYT Upshot piece on innovation in health care, Aaron Carroll and Austin Frakt argue that the U.S. subsidizes other countries health care by paying higher prices for prescription drugs. This is far from obvious.

Since the U.S. grants patent monopolies and then puts no checks on prices, brand drugs do cost far more here than elsewhere, but that doesn't mean that other countries are not paying enough to support innovation. The price of patent-protected brand drugs is on average around ten times their free market price. In Europe and Canada, prices are around half the U.S. price which means they are around five times the free market price.

This gap between the patent-protected price in other wealthy countries and the free market price should be more than enough to support the research done by the pharmaceutical industry. (They claim to spend around $50 billion a year on research directly. Even adding in what they pay to buy up other companies only gets to around $100 billion, a bit more than 20 percent of annual U.S. spending on drugs.)

European levels of spending may not be sufficient to support the marketing and profits of the U.S. industry, but that speaks more to the inefficiency of the U.S. industry, not the failure of other countries to pay for research. It is also worth noting that without the perverse incentives created by patent monopolies, the research process would almost certainly be more efficient.

There would be no incentive to spend money researching duplicative drugs simply to share in the patent rents of a breakthrough drug. This doesn't mean that it is not desirable to have multiple drugs for a specific condition, but the priority of developing a second, third, or fourth drug for a condition where an effective treatment already exists is almost certainly lower than developing a drug for a condition for which no effective treatment exists. Ending the reliance on patent-supported research would also take away the incentive for drug companies to misrepresent the safety and effectiveness of their drugs.