The $3.5 trillion reconciliation bill was meant to be, in the words of its principal author Bernie Sanders, “the first time in American history that Congress would have stood up to the pharmaceutical industry,” allowing Medicare to negotiate pharmaceutical manufacturers for lower drug prices, among other things. But that provision is now in trouble, thanks to Democratic centrists working overtime to ensure that first time never happens.

A recent report from Public Citizen suggests how much Big Pharma stands to lose if such a program became law. According to the report, United We Spend, America’s uniquely corporate-dominated health care “system” has also been uniquely lucrative for pharmaceutical companies, bringing them profits far outstripping what they grab in the rest of the world, all at the expense of the ordinary Americans paying sky-high prices for lifesaving medicine.

Comparing publicly reported US and global sales revenue, Public Citizen found that US residents spent nearly double the entire rest of the world for the top twenty best-selling drugs on the globe, and that US sales revenue for seventeen of the of the medicines was greater than that of every other country combined. In other words, with roughly 3.7 percent of the world’s population, the United States was responsible for 64 percent of these drugs’ sales revenues in 2020.