Saum Sutaria, M.D.

But think about, again, what you just said. That may be true in the short term, but the hallmark of American ingenuity is to take externalities. This is an externality that might be relevant. Take that pressure. In that ecosystem, better models emerge. More efficient drug development will emerge. More efficient distribution mechanisms, more efficient sales and marketing, et cetera, will emerge.

But think about, again, what you just said. That may be true in the short term, but the hallmark of American ingenuity is to take externalities. This is an externality that might be relevant. Take that pressure. In that ecosystem, better models emerge. More efficient drug development will emerge. More efficient distribution mechanisms, more efficient sales and marketing, et cetera, will emerge.

I mean- It's always the case as companies have life cycles that shareholders succeed and at times suffer. But the innovators come out the back end stronger and sometimes they're a new entrance, which changed the game. I mean, that's the hallmark of the free market economy.

I mean- It's always the case as companies have life cycles that shareholders succeed and at times suffer. But the innovators come out the back end stronger and sometimes they're a new entrance, which changed the game. I mean, that's the hallmark of the free market economy.

Yeah, right. I mean, this is what people get into. But there's two issues there. First of all, I don't think that – remember, we took all the time to describe the entire complex pharma ecosystem. It's not just the pharmacos. There are companies that do basic research. There are pharmacos, there are PBMs, there are pharmacies, there's insurance.

Yeah, right. I mean, this is what people get into. But there's two issues there. First of all, I don't think that – remember, we took all the time to describe the entire complex pharma ecosystem. It's not just the pharmacos. There are companies that do basic research. There are pharmacos, there are PBMs, there are pharmacies, there's insurance.

By the way, the insurance companies own the biggest PBMs. So there's a vertical integration point there that is important to understand. My point is that when you talk about this in terms of Medicare purchasing drugs with their scale, it is absolutely the case that that that can be done in a market-based way. By the way, Walmart is one of the biggest retailers in the country.

By the way, the insurance companies own the biggest PBMs. So there's a vertical integration point there that is important to understand. My point is that when you talk about this in terms of Medicare purchasing drugs with their scale, it is absolutely the case that that that can be done in a market-based way. By the way, Walmart is one of the biggest retailers in the country.

Arguably, they have one of the best procurement functions based upon the scale of what they're purchasing that gets them better pricing from their suppliers. Auto manufacturers manage this in auto supplier, part suppliers. It's not un-American to use scale as long as that scale is not anti-competitive, to drive better pricing in what you purchase.

Arguably, they have one of the best procurement functions based upon the scale of what they're purchasing that gets them better pricing from their suppliers. Auto manufacturers manage this in auto supplier, part suppliers. It's not un-American to use scale as long as that scale is not anti-competitive, to drive better pricing in what you purchase.

It creates innovation across the entire value chain. Medicare, in this case, because it has become such a large source of expenditure in a private healthcare marketplace, behaving more like a primary buyer at scale is not anti-American. How How it gets implemented and how they do it could turn anti-American. I'm using your term, anti-American, free market versus not.

It creates innovation across the entire value chain. Medicare, in this case, because it has become such a large source of expenditure in a private healthcare marketplace, behaving more like a primary buyer at scale is not anti-American. How How it gets implemented and how they do it could turn anti-American. I'm using your term, anti-American, free market versus not.

But purchasing at scale is not an anti-American or anti-competitive concept.

But purchasing at scale is not an anti-American or anti-competitive concept.

I think it'd be very difficult to move in one move to that level legally. of purchasing price given what the starting point is in the marketplace. I don't see how you could do that without really having a shock to the industry.

I think it'd be very difficult to move in one move to that level legally. of purchasing price given what the starting point is in the marketplace. I don't see how you could do that without really having a shock to the industry.

I mean, let's remember, I think 80% of the pharmaceutical industry resides and generates profits in the US as large employers, but not just large employers, large magnets for talent coming out of our universities. We have to remember between them and their supply chain, they create a lot of innovation, right?

I mean, let's remember, I think 80% of the pharmaceutical industry resides and generates profits in the US as large employers, but not just large employers, large magnets for talent coming out of our universities. We have to remember between them and their supply chain, they create a lot of innovation, right?

I mean, a tremendous amount of innovation in this country that has advanced, you can call it health 2.0, but it's advanced health 2.0 because that's the construct we have. So this has to be balanced. But the concept that a purchaser at scale can achieve better pricing, I would argue the time for that legislation from the 2000s to be revisited is here.

I mean, a tremendous amount of innovation in this country that has advanced, you can call it health 2.0, but it's advanced health 2.0 because that's the construct we have. So this has to be balanced. But the concept that a purchaser at scale can achieve better pricing, I would argue the time for that legislation from the 2000s to be revisited is here.