Standing in line at the pharmacy. Watched a man pay $900 for a monthly prescription. Must absolutely need that medicine. Wondered what sacrifices he and his family make to pay that much.

That was my wife’s experience last week.

Data shows such situations to be regular occurrences. Republican Sen. Chuck Grassley of Iowa posted that 58 million American adults can’t afford prescription drugs; that 34 million American adults know someone who died because they couldn’t afford treatment; that nine in 10 U.S. adults report that the costs of prescription drugs are “usually much higher” (69%) or “tend to be somewhat higher” (20%) than what consumers should be paying.

As families struggle, pharmaceutical companies rake in billions. That seems far out of balance.

Former President Donald Trump thought so. On Dec. 7, 2016 he said, “I’m going to bring down drug prices.” He told Time Magazine, “I don’t like what has happened with drug prices.” His 2016 health care plan stated, ““Congress will need the courage to step away from the special interests and do what is right for America…. Though the pharmaceutical industry is in the private sector, drug companies provide a public service.”

He was unable to find enough congressmen, mostly Republicans and some Democrats, with such courage.

Now that ball is in the Democrats’ court. President Joe Biden’s Build Back Better omnibus would address some drug costs. But no Republicans and not all Democrats are on board. The provision may get kicked out in the Senate.

The radical changes needed to improve drug pricing don’t ever seem to get on the table.

Think free market capitalism. Then look at the monopolistic practices of this government subsidized industry.

The National Institute of Health pumps billions into basic pharmaceutical research. R&D tax credits provide billions. 20-year patents on developed drugs provide monopolistic control with no restraint on pricing.

We’re talking about really big money here. In 2020 worldwide total revenues topped $1.2 trillion with profit margins about double that of large non-pharma companies.

This anti-competitive process has led major drug companies to all but abandon low-margin but still life-saving drug production. Examples: research into vaccines lagged until COVID-19 hit and the government issued a blank check for new vaccines; drug-resistant diseases kill hundreds of thousands annually but research to find new antibiotics has been scant.

Yet there is plenty of money to hire lobbyists. A recent report showed the industry with nearly 1,500. Just during the 2016 congressional elections the industry spent $62 million on lobbying. Such expenditures helped defeat Grassley’s Prescription Drug Pricing Reduction Act of 2019.

And there is plenty of money to pay billions for TV and Internet advertising. A study by the Journal of the American Medical Association found the number of ads increased from 79,000 in 1997 to 4.6 million in 2016.

Without action prices will continue to escalate.

Medicare last month announced an increase Part B costs to pay for the controversial new Alzheimer’s drug Aduhelm by Biogen. It costs $56,000 annually. Novartis’ new gene therapy drug Zolgensma will cost $2.125 million.

“And if you make a sale to your neighbor or buy from your neighbor, you shall not wrong one another” – Leviticus 25:14.

Crawford is a syndicated columnist from Jackson.