What would you sacrifice for your health? Too often, the question isn’t a hypothetical. Over a third of the world’s population lives without access to the medicine and professional care they need to survive. For some, the question isn’t whether to choose a branded or generic drug on a given month, but whether they should opt to buy food or fill their prescription. The cost of fighting – or even preventing – illness has skyrocketed, leaving healthy and ill people across the world in the grip of a care crisis. The situation begs for reflection; how did we become ensnared in this untenable situation? Perhaps more importantly, how do we get out of it?

As I hinted at earlier, cost is at the crux of our current dilemma. Despite the considerable funds poured into pharmaceutical research and development, there is a dearth of a affordable care in low- and middle-income countries. While treatment is technically within reach, those with serious illnesses often don’t have the resources needed to obtain them, and are thus left without access to medicines they desperately need. Pharmaceutical representatives often cite the high cost affiliated with drug development as the reason behind sky-high pill prices – and at first glance, the reasoning seems fair; after all, innovation does have a price tag. But should the tag be quite so costly?

A troubling report published by the United Nations Secretary-General’s High-Level Panel on Access to Medicine found that governments are often “subjected to undue political and economic pressure to forgo the use of TRIPS flexibilities.” To contextualize: TRIPS, or the Agreement on Trade-Related Aspects of Intellectual Property Rights, is an international bond which allowed UN-member countries to, among other actions, temper excessive medical care prices. By pushing back against the flexibilities TRIPS allows, corporate and political interests undermine government attempts to further human rights and public health initiatives, and ultimately harm national healthcare programs.

Let’s consider the United States as a case study for a moment. When compared to other countries, the States has a higher infant mortality rate, lower life expectancy, and higher trends of chronic disease than similarly wealthy countries. Bewilderingly, residents of the United States pay significantly more for prescription medication than those in France or the UK, even though the U.S government spends more per capita than either of the European countries do on health costs. The seeming illogic may be due at least in part to America’s policies regarding the healthcare industry. Interestingly, while both Medicare and Medicaid are blocked from negotiating pill prices, they are required to cover all FDA-approved drugs, regardless of cost. While this doesn’t necessarily contribute to the high cost of prescription medication, it certainly doesn’t limit it – though it has the potential to do so. Unlike the programs mentioned above, the Veterans Health Administration does have the power to negotiate drug prices – and pays 80% less for drugs as a result.

The UN report mentioned above concluded its findings with a call for transparency, noting that doing so would “introduce some measure of reason and evidence into heated pricing debates, which too often deteriorate into hyperbolic claims that any interference with free-market pricing would destroy innovation.” Medical innovation is expensive, but living without fear of losing access to vital medicine shouldn’t be. For us, the question shouldn’t be “why are drug prices so high?” but “can they be lower?” Pharmaceutical companies and governments need to work together in order to resolve our global health crisis and ensure that no one is forced to choose between buying groceries and filling a prescription.