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And the largest portion of that is due to specialty drugs.

I would like some evidence of this. I've read and heard many people confidently pin the high cost of health care on: too much administration, greedy doctors, undocumented immigrants, over use of tests, over prescription of drugs, too much paperwork causing inefficiency, and probably others I'm forgetting. They can't all be the primary cause.

[ and before someone replies, it is a mix of those, of course ]

Perhaps the primary cause is a profit motive.

In competitive markets, competition will keep costs and profits from ballooning.

What kind of market conditions are required for spending to increase in all sorts of directions? I can immediately point to education as an example where both lenders and colleges both have a vested interest in growing eachother's businesses, paid for by the customer.

Total pharmaceutical spending is about 10% of all medical costs. Specialty drug is probably less than half.

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