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One possibility floated by economist Dean Baker is for the US government to invest $100b/year in clinical trials, keeping the patents for itself and licensing multiple manufacturers to compete to produce these publicly owned drugs, which would save an estimated $500b/year:

https://cepr.net/financing-drug-development-what-the-pandemic-has-taught-us/

Then there's price-gouging, useless middlemen like Group Purchasing Organizations who soak the public purse for $20b/year - a "moderate" enforcement action could cut that to $10b.

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