Question special

The "value" was briefly discussed in a previous question. But I'm not sure if we have established why this exam is so costly. For more than a decade, many organizations such as the AMA and the AAMC have urged the USMLE to reduce the price of the exam. However, not only has it not gone down, it's getting more expensive. Why does it cost $1,275, when standardized patients get paid $16-20? How can we begin to reduce the price? What incentive is there to lower the price when it is a monopoly with an inelastic demand curve?