Here in Australia the state funds most medical care. In this case the blackmail vector, if we use that interpretation is the taxation system.
https://en.m.wikipedia.org/wiki/Pharmaceutical_Benefits_Sche...
The blackmail version is actually "Refuse, and we'll produce a generic version locally and perhaps even export it to any country that wants it."
Note that a mixed economy (combined public/private funding, like the french and australian systems) are probably for the most part the most economically efficient. A big problem in australia is over-provision of services, especially ending up getting more pathology tests than strictly necessary.