Speaker 1: The main objective of health care reform is to broaden access to quality care. Instead of expanding government programs and subsidies, the direct pathway rests on reducing the cost of care itself. This requires creating conditions long proven to bring down prices while improving quality, incentivizing consumers to seek value, increasing the supply of care, and stimulating competition. First, equip and incentivize consumers to consider price. Critics often claim this is unrealistic. How can you shop around from the back of an ambulance? But emergency care represents only 6% of health spending. For privately insured adults under age 65, almost 60% of expenditures is for outpatient care. For the top 1% of spenders responsible for more than a quarter of all health expenditures, a full 45% is outpatient. Studies from MRI and outpatient surgery show that when patients are motivated to consider prices, prices come down by almost 20%. And we may not even need legislation to force the visibility of prices. The most compelling motivation for doctors and hospitals to post their prices would actually be their understanding that they are suddenly competing for price conscious patients who control the money. Obamacare moved in the opposite direction. Its extensive coverage requirements and misguided subsidies encouraged bloated coverage and furthered the counterproductive idea that insurance should minimize all out-of-pocket payment. When insurance pays the tab, patients have little reason to consider costs, and doctors don't need to compete on price. Effective reform would put patients in charge of their own spending while giving them a way to gain from paying less. One essential component is widely available high-deductible insurance plans with fewer coverage mandates and cheaper premiums. Higher deductibles require direct patient payments for care up to the level of the deductible. A second highly effective tool to motivate patients to care about price is large, liberalized health savings accounts, or HSAs. Tax-sheltered HSAs typically pay for non-catastrophic expenses, which form the bulk of medical care. And better than tax deductions, HSAs actually incentivize saving. And when people have savings to protect in HSAs, the cost of medical care comes down without any harmful impact on their health. Large HSAs should be available to everyone, and that includes seniors on Medicare because they're the biggest users of health care. Motivating seniors to seek value is really crucial to driving prices lower. Raising maximum contributions to HSAs, allowing the HSAs to be used for the countholder's elderly parents, and permitting rollovers to surviving family members are additional, important reforms to consider. Second, increase the supply of medical services to stimulate competition. In large part, this means removing barriers like unnecessary scope of practice limits on qualified nurse practitioners and physician assistants. When clinics staffed by nurse practitioners and physician assistants provide simple primary care, like vaccinations, blood pressure monitoring, treating routine infections, that care is 30-40% cheaper than when given by a doctor, and patients are highly satisfied. Medical school graduation numbers have stagnated for almost 40 years, and residency training programs have limited the supply of doctors, despite known projections of shortages. This is anti-consumer. National MD licensing would help telemedicine proliferate across state lines. Finally, an often overlooked problem is the unlimited income tax write-off for health expenses. This encourages higher demand for care, regardless of cost, while distorting insurance into covering almost all services. Remember, in other countries, governments hold down costs by limiting medical care, limiting drugs, and limiting technology, and they get the expected results, long waits and worse medical outcomes, particularly for the poor, who are the only ones unable to circumvent those systems. We should consider a different approach here. Let's create incentives and eliminate harmful regulations to reduce prices so that high-quality care becomes affordable for everyone.