As summarized by the Kaiser Family Foundation, the 2010 Affordable Care Act (ACA), commonly referred to as Obamacare, aimed to make health coverage more comprehensive, cheaper for people who already had insurance, and accessible to citizens who were previously barred by pre-existing conditions. However, the results have been mixed. While the ACA’s Medicaid expansion provided vital help to people who went far too long without coverage, people insured through their employers have been increasingly crushed by soaring deductibles.

In 2015, physician Praveen Arla told USA Today that the state of healthcare “flip-flopped” from what it was before the ACA. According to Arla, patients with employer-based insurance would often lament, “‘My deductible is so high. I’m trying to come to the doctor as little as possible.” Meanwhile employers have increasingly gravitated toward high-deductible insurance plans as a cost-cutting measure. Citing the Centers for Disease Control and Prevention, CBS reported in 2019 that four in 10 Americans have high-deductible plans.

Assuming patients don’t eschew healthcare altogether, the basic alternative would entail paying a lower deductible but a prohibitively high monthly premium. Either way the fees for procedures and medications can be outrageous. For example, adjunct professor Robyn Hodgson couldn’t purchase pain medication after back surgery due to the $7,300 deductible she’d have to pay before her insurance chipped in. She received that coverage through her husband’s job, which cost them $6,500 a year in premiums.

According to a Rand Corporation report from 2019, the world collectively spends around $1 trillion on drugs annually. The United States accounts for about half of that total despite making up only five percent of the global population. Preposterously, three percent of America’s entire GDP comes from drug costs. But while the prices patients pay far outpace the rest of the world, the results lag behind other developed nations. The Harvard Gazette says that in 2016, the U.S. spent twice as much on healthcare as other high-income countries but ranked dead-last in life expectancy on a list of 10 other countries.

Why does America so much more for less? The Rand Corporation observes that “every other country in the world regulates drug prices, typically through some formal process of negotiation. Only we don’t.” Instead, pharmaceutical companies call the shots. The FDA effectively allows them to monopolize drugs via patents. And because greed is bottomless, drug companies boost their bottom lines by exploiting legal loopholes.

As USA Today details, drug patents generally last 20 years. Once you subtract the time it takes for approval, pharmaceutical manufacturers can “expect anywhere from seven to 12 years of protection.” However, they can extend that time through the dubious practices of “evergreening” and “thickening.” Thickening entails inundating the courts and Patent Trade Office with applications in order to overwhelm the system. “Evergreening involves making small alterations to a drug” even something as insignificant as “adding a stripe to a pill” and applying for a new patent.