It costs up to $800 million to take a new drug through the approval process. And that's if it gets approved or not. For a newer drug company, with a smaller set of products, a thumbs-down from the FDA can cut their stock price in half.

If the drug companies weren't allowed to make this up in sales, or insurance companies just decided not to cover the expensive ones any more, the drugs simply wouldn't exist. There aren't enough rich patients to make it work by charging the real prices.

Of course, we'd never miss drugs we don't have. Or maybe we would. What would you be taking if that drug wasn't available?

My wife is on an injectable that would cost us a couple of thousand a month of insurance didn't pick it up. As far as transparency goes, the company makes no secret of what it costs, and the insurance company makes a point of telling us too. Hospital billing is weird, with that mythical intitial price that gets charged and nobody pays, but all the numbers are right there.

To be sure, that pricing is all after the fact. It is harder to figure out the costs ahead of time, but under a system where the customer isn't paying most of the bill there's no real incentive for up-front pricing anyway, never mind competitive pricing. You find out when the insurance company (or the government if you live in a socialist paradise) decides if it's something they want to pay.

If you want the medical system to work right, it has to be eased back to where market forces can go to work again, and the choices make a difference to the customer.