I think the &quot;monopsony==inefficient market&quot; argument is a fig leaf for the shibboleth that state economic actors are somehow &quot;tainted&quot; because they&#x27;re not &quot;private&quot; enterprises. If a pharmaceutical firm were &quot;negotiated&quot; (tortured?) below their break-even somehow by state actors, they would simply fold. The entire concept of &quot;below efficiency levels&quot; is questionable here.