But in the U.S., a different calculation is at play. By using its buying power to lower prices, the U.S. might get a better price on a drug currently sold or one that would be on the market in the next few years. But if drug prices fall in the U.S., the risk of putting money behind new treatments that are still many years away might be less attractive for investors. That could be a problem for a country that prides itself on drug innovation and provides the most cutting-edge care.

“We want to get both low prices and access and all the new drugs. And you don’t get all three of those. You’ve got to make some choices here,” said Garthwaite. “If you want to make sure that everyone always gets access to every product, then you’re going to pay high prices.”

Under Jayapal’s bill, the U.S. would likely have to employ what other countries call “health technology assessment” or “cost-effectiveness research” to measure the overall benefits to the health care system from deciding to cover a new drug, device or procedure. This is different from regulatory approval, and more like what private insurers do in the U.S. before deciding whether something is worth covering. The question: Is the price worth it?

In the United Kingdom, the board that makes those kind of decisions for its National Health Service decided that one of the groundbreaking new gene therapies for certain blood cancers was not worth it. Germany’s system for assessing cost-effectiveness and setting prices for certain treatments has resulted in some drug companies deciding not to sell their products because prices were too low.

But countries usually make these decisions because there are other options, said Osborn of the Commonwealth Fund.