I love travel for the perspective it lends: the chance to see how different cultures approach everyday life. On a recent trip to Southeast Asia, one of the most striking differences appeared in an unlikely place—shopping.
Back home, the price on the tag is the price you pay. In the markets of Thailand and Cambodia, the number you see is more of an opening bid than a final answer. Prices are set high on purpose because bargaining is part of the ritual. And as an American, I never felt entirely sure I was doing it “right.” I didn’t speak the language, I didn’t know the going rates, and I couldn’t tell whether I’d paid more than the person standing beside me.
It wasn’t until I walked away with a small gift—one I’m fairly certain I overpaid for—that the parallel clicked. This is what healthcare pricing feels like in the United States.
Our “sticker prices” are built for negotiation in a country where people don’t have the ability to negotiate at the point of sale, don’t understand the specialized vocabulary, and have no dependable sense of what things should cost. No wonder health care pricing feels wrong. It’s not just expensive, it’s disorienting.
We often use the terms “price” and “cost” interchangeably, but that also adds confusion. The price is what someone charges you for something, and the cost is what you ultimately pay for it.
There’s a lot of discussion about “middlemen” in healthcare right now: insurance companies and pharmacy benefit managers (PBMs), whose roles are to drive down costs on behalf of clients and their members. Here’s what’s rarely said: if we eliminate the parts of the healthcare ecosystem that negotiate down prices without fixing the underlying pricing model, we don’t get a simpler market. We get a market where producers have even more leverage and less resistance. That’s not disruption; that’s a gift to profiteers.
At a time when healthcare affordability is at an all-time low for Americans, we can’t afford to remove any levers that lower costs unless we’re replacing them with something better—more transparent, more competitive and simplified pricing allowing patients and employers to effectively navigate needed care.
Hospitals and health systems set high list prices in their chargemasters expecting payers to negotiate what they’ll actually reimburse. Few people with insurance pay the list price. The insurer bargains down the cost on the patient’s behalf. Yet this negotiation is competitive information and largely invisible to the patients and employers footing the bill.
Medications have a similar dynamic. Manufacturers set (and often increase on a regular basis) list prices. At the start of 2026 alone, pharmaceutical companies have already increased the list price for over 850 branded medications. PBMs negotiate rebates and discounts, and those negotiations reduce net prices. But the flow of money—rebates, fees and discounts—has historically been hard to see and understand. It’s why the PBM industry is so focused on opportunities to use transparency to rebuild trust in the system.
If prices set by drug companies, hospitals and doctors were at reasonable, competitive levels—and everyone simply paid the posted price—we wouldn’t need middlemen. But that’s not the system we have today.
Healthcare is a marketplace, but not one ordinary buyers can navigate with confidence. Prices are opaque, terminology is foreign and the “right” price is murky. So we face a choice: leave individuals to negotiate alone, or help by negotiating on their behalf. Many employers choose the latter, engaging insurers and PBMs precisely because expertise and scale deliver better prices than scattered, single-case bargaining with drug manufacturers or hospital systems ever could.
Our path forward is clear: shine light on prices, strengthen competition and build a system where Americans finally know, and can afford, the cost of care. Our health and our financial stability depend on it. If we don’t succeed, the seller will win—every time.
Amy Compton-Phillips, M.D., is executive vice president and chief medical officer at CVS Health.