I'm surprised on the comments here that go: "I had to pay $$$$ for a medication when I could buy that same medication somewhere else for a fraction of it. Therefore Big Pharma gouges America".

That is not evidence that "Big Pharma gouges America". It is evidence that Americans pay a lot more than other countries. Only that. The conclusion doesn't necessarily follow from the premises.

Want to understand why? Read the article's last paragraph:

> The bulk of the rents is captured instead by providers of health-care services such as hospitals and the system’s true money-makers: insurers, pharmacy-benefit managers and other middlemen taking advantage of its opacity.

As always, no one reads anything.

> Insurers make even less money than Pharma companies do.

In the whole or in relative terms? Source, even if personal or anecdotal?

I am willing to consider your point because, to be fair, the article doesn't show any data that indicts the insurers. They just blame them at the end without any evidence.

> all health care spending goes to companies that deliver health services directly.

Well, that wouldn't explain why medication alone is more expensive in America, right?

But accepting your argument: is it because of greed and oligopolies, incompetence or excess of regulation?