Government Monopsony and Its Biological Consequences: How Price Controls Sabotage the Conservation of Human Life Gary Puckrein, PhD, President and CEO, National Minority Quality Forum April 19, 2026

https://www.healthaffairs.org/sponsored-content/national-minority-quality-forum/government-monopsony-and-its-biological-consequences-how-price-controls-sabotage-the-conservation-of-human-life?utm_campaign=34032557-Health%20Affairs%20Sunday%20Update%202026&utm_medium=email&_hsenc=p2ANqtz-9yu0Njpw8iWZBzfz7awbiJdiw1NVFJa32S5Hk7Vb_d_QpmUoirkiQNlSe0MZmlhTaHIdgPx9HqN5JJ_KRmxm4qon4VOA&_hsmi=415566602&utm_content=415566602&utm_source=hs_email Consider two facts that rarely appear in the same sentence. First: a tumor in an untreated patient does not pause its molecular evolution while a prior authorization appeal works its way through administrative channels. Mutations continue accumulating, clonal selection continues favoring therapeutic resistance, and disease advances through biological stages — indifferent to bureaucratic timelines. Second: the United States federal government has, through the Inflation Reduction Act (IRA) and Most Favored Nation (MFN) drug pricing policies, assembled the most comprehensive architecture of pharmaceutical price control in its history — multiple interlocking mechanisms operating potentially on the same drugs and in the same markets, whose combined effect on patients is greater than any single mechanism would produce alone.