Agreed, it’s crazy. Making healthcare contingent on employment is barbaric but aligned with other practices (like W2 tax withholding) where the government effectively deputizes your employer to enforce the civic contract.
I’d bet the $800/mo eyedrops this poor lady is relying on don’t cost that much in any other country (and I don’t mean poor countries - I mean in other rich countries like Japan, Singapore or Australia). So when she switches to Medicare as soon as she turns 65, how much are the US taxpayers paying for these eyedrops? It’s just wealth transfer from US taxpayers to the US medical industry complex.
So I fear “Medicare for All” would simply mean we pay even more taxes than we already do now and the US government will keep spending insane amounts of money on healthcare as compared to every other developed nation in the world with no better outcomes.
For example, if the generic option reduces the burden of disease by 10 DALYs and costs essentially ~0$ it will be fully covered, any other patented option with a 15 DALY average benefit will be covered up to a financial ceiling given by the total funding available and the extra 5DALY benefit it brings. A patented option that does not fit that ceiling will require patients to pay from their pocket, therefore cratering sales, therefore strongly incentivizing the pharmaceutical company to lower the price to fit the ceiling.
This is how other advanced countries lower spending on drugs without infringing on intellectual property - by forcing all manufacturers of all drugs for all diseases to compete on price, or risk selling basically nothing in that country until their patents expire. Since the marginal production cost of drugs is close to zero, it' always better to have some sales at some lower prices instead of no sales at a very profitable price.
I think in a way Americans are actually subsidizing pharmaceuticals for consumers in other countries because pharmaceutical companies are willing to sell the same product for less to them because as you said their marginal production costs are minimal and they have already recuperated a great return on their R&D investment from American consumers.