I think the problem is that the patient doesn't pay for the drugs directly. The insurance companies pay the pharmacies the exorbitant fees, then raise the cost of insurance just a little for everyone, yet both the pharmacies and insurance companies profit. Also, I don't think most people in the U.S. get to choose their insurance provider, their employer does it for them. In Canada most health care (but not drugs) are paid for through taxes, so no insurance companies get involved directly.