Regs probably the biggest, regs themselves are a product of their environment.

The US being where investment goes, and the market where approval trickles down from to the rest of the world, that's where most Lawfare happens

Lawfare manifests as Regs, as Regs are costs imposed on competition

US's scale also draws in corruption, regs increase costs, costs are used to justify more subsidies to where the system has become a setup to print money directly into the medical industrial complex...

Combined we have the illusion of a free-market system, running socialism under the hood. This yields the worst of both, corporatism.

The zeitgeist under the new regime is "favored nation" pricing on drugs so that the US stops subsidizing drugs for the rest of the world by overpaying, and cutting the insurance companies out of the subsidy flow to open the market to choice.