Greed from the drug, and insurance companies. Like a business, if we only need to deliver a few dozen items we make a week, we use a 3rd party. US mail, fed Ex, and other private companies. That way the cost, it not worth buying a truck, insurance, hiring a delivery driver, and a few workers to handle paper work. But when a company gets bigger, and does 3-4 dozen a day, then its worth it. Same goes for medical. from treatment, to medicines. Once a drug becomes generic, the government, who could make the drug, for pennies, should. The government is paying the bill anyways. Medicare for seniors, its known how many people need Blood pressure, Diabetes, heart, liver, and other illnesses, meds. So if we know 2 million seniors need BP meds, and we the government is going to pay it, why not get the best price. But the drug and insurance companies get congress to not allow the government or employers to negotiate for a cheaper price. Same thing is happening with Internet, and cable. We Americans pay twice as much as other modern and even some 3rd world countries, and we get less. lower speeds, unless we pay even more. And some places we have no choice but one company.