Market failure and the failure of discourse: facing up to the power of sellers.

The United States spends far more than other countries do on its health care system, but comparative data strongly imply that Americans are not receiving their money's worth. There is much hand-wringing about spending, but little attention is paid to the main culprit: lack of market power by purchasers-something that exists in nearly all other countries. This lack of attention is not surprising, however, given that having an open discussion could ultimately lead to more regulation-and a major redistribution of resources away from providers and back to employers, individuals and families, and taxpayers.