Neera Tanden

And so it basically the fractured system allows a bunch of people to drive up costs.

A big area where things are just much more expensive in the United States is hospital care.

It's just, and those hospitals often have a monopoly and no individual group is using their, has enough market power to really drive costs effectively down.

So it's a very inflationary system.

So I don't have like a much better answer than it's complex and that's what makes it more expensive.

But essentially you have a system that is super fractured and in a way,

Everyone looks at somebody else to lower the, to be transparent.

What we should do is have everyone be transparent.

The hospital should be really clear on what it costs.

And, you know, I do think that there is an additional problem in the United States, which is because people don't have health insurance, there are a bunch of forces, like hospitals shift costs, right?

I mean, we've insured a lot of people in the United States, particularly after the ACA, but there are some people who still don't have coverage and they shift costs to others to sort of pay for that.

So it's two complicated things.

But what we should do is have radical transparency everywhere, get rid of the PBMs.

There's a lot of self-dealing in the system as well, and that would make it a lot better.

There are states that have done really effective things.

And I'll give an example.

So it's to use the power of the government, not to set price caps, but to basically try to negotiate with all the insurers.

Insurance is regulated in the United States basically at the state level for the most part.

And so...

very similar to the German model where you have kind of bargaining between all the employers and all the insurers to set, the government kind of oversees to set lower prices for insurance.