Why Health Care Needs Buyers Willing to Say No

In a provocative new opinion piece, health economist Anthony T. Lo Sasso argues that the U.S. health care system's biggest players—insurers, hospital systems, and employers—have little appetite for change. He contends that the persistent rise in medical costs stems from a fundamental failure: no one is willing to say no to higher prices, unnecessary services, or inefficient care delivery. Lo Sasso points to the consolidation of hospitals and physician practices, which has given providers outsized negotiating power, while insurers often pass costs along to consumers through higher premiums. The result is a system where spending continues to climb without corresponding improvements in quality or outcomes. His analysis suggests that meaningful reform requires purchasers—whether government programs or private employers—to take a harder line on prices and utilization. Without such pushback, Lo Sasso warns, the health care cost crisis will only deepen, squeezing household budgets and public finances alike. The takeaway: until buyers start acting like true customers, health care will remain the one market where saying no is treated as heresy.