This system has never worked well, but it's working even less well now because of the profusion of high-deductible health insurance plans. Many ordinary Americans who haven't reached their deductible limits are being exposed to high list prices that were intended to be no more than a starting point for negotiations between powerful institutional sellers and buyers. In other words, a price that was basically fake has become all too real. This is what Bresch argued in an interview on CNBC on Aug. 25: “It was never intended that a consumer, that the patients, would be paying list price, never. The system wasn't built for that.”
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