Nationwide, prescription drug spending last year is estimated to be $328 billion among all payers, including private insurance, Medicare Part D, and patients’ out-of-pocket expenses. Reforms to let Medicare negotiate prices, cap out-of-pocket costs for prescription drugs, and limit insulin cost-sharing would make lifesaving drugs more affordable. Still, the pharma industry is fighting hard to keep it off the table.

A federal appeals court rejected Pfizer’s challenge to a U.S. anti-kickback law that the drugmaker said prevented it from helping heart failure patients, many with low incomes, afford the medicine that costs $225,000 annually. For many, these coupons represent the difference between filling a prescription and going without lifesaving care, but there is a lot more here than just a co-pay coupon.

Imagine a medicine that reduced the death rate of breast cancer and risk of recurrent breast cancer by 50% lowered the risks of colon cancer and type 2 diabetes by two-thirds, and those of heart disease, hypertension, and Alzheimer’s’ disease by 40%. On top of that, it can be as effective as antidepressants or cognitive behavioral therapy in countering depression. That medicine exists, says Dr. Edward Laskowski of the Mayo Clinic: It’s’ called exercise. But…

Approximately 96 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% don’t know they have it. Prediabetes increases your risk of developing type 2 diabetes, heart disease, and stroke (Source: CDC). Almost half of older adults — more than 26 million people 65 and older — have prediabetes. That’s a clear and present danger to our country.

 Advanced economies typically spend about 10% of GDP on keeping their citizens in good health, a share that is rising as populations age. America’s profit-riddled healthcare-industrial complex consumes 17% of GDP, equivalent to $3.6trn a year. That is unsustainable. However, changes are slowly being implemented that could lower healthcare costs.