You're correct in stating that the NIH invests heavily in medical research, but it's important to note that the pharmaceutical industry spends even more. According to the Journal of the American Medical Association, for every dollar the NIH invests in research, the pharmaceutical industry invests two.

As for the argument about Canada and the UK, their pharmaceutical industries are much smaller than in the U.S. The U.S. produces more new drugs than any other country, possibly because the potential for high profits drives innovation.

Your idea about a tiered or case-by-case approach is intriguing, but it might be quite complex to implement. How would we decide which drugs fall into which category? It sounds like a potential administrative nightmare.

What if instead, we focused on increasing transparency in the pharmaceutical industry, so we can better understand why drug prices are set the way they are? Perhaps that could be a more practical solution to start with. What are your thoughts on this?