Secretary Kennedy, the cheaper operating room in Massachusetts requires the expensive hospital’s permission to open. That belongs in the speech. The Boston joint replacement gap is real. Blue Cross reported commercial claims prices ranging from $17,910 to $73,987 in the Boston market in 2015. More than a decade later, the spread is being presented as a revelation. Look at who gets permission to compete. In 2008, Massachusetts removed the exemption that let physician-owned surgery centers open without Determination of Need approval. The state’s own Health Policy Commission calls what followed an effective moratorium on new ASCs. In 2017, the state lifted it with conditions. New centers needed an affiliation with a certified accountable care organization. A center in an independent hospital’s primary service area needed that hospital’s approval. The commission’s conclusion: the requirements effectively gave hospitals approval power over most new surgery centers. The incumbent gets a say in whether its competitor opens. In the commission’s 2023 data, Boston had one ASC. Then there is the payment system you oversee. Medicare still pays hospitals more for many services that can safely be performed in independent offices or surgery centers. CMS has narrowed some of that gap. In 2026, it expanded site-neutral payment to drug administration at certain off-campus hospital departments and expanded the ASC covered-procedure list. It has proposed adding imaging without contrast at those departments for 2027. Good. Keep going! A hospital billing address is not better care. Paying extra for it grants an advantage before anyone compares outcomes. That policy does not establish what caused the Blue Cross spread. It does expose the contradiction: Washington condemns the expensive setting while still paying a premium to use it. The insurance finding is separate. Trinity College reported that economist Gerardo Ruiz Sánchez found 60 percent of the negotiated rates he studied exceeded the hospital’s own cash price. Patients pay premiums expecting bargaining power. They deserve to know when the hospital’s cash offer was better. Publishing the price is not the same as being allowed to take it. If a plan shows the cheaper option and then makes choosing it cost more out of pocket, it has built a museum of affordable care. Please enjoy the prices without touching the savings. For scheduled care, the buyer needs an offer that can be accepted: a defined episode, a named physician and facility, meaningful quality information, and a price agreed before treatment. The benefit design has to let the employer and the patient to keep the difference. The competitor has to be allowed to open. Markets cannot discipline prices they cannot see. They also cannot discipline a hospital whose competitors need permission to open. Publish the prices. Stop protecting them. @SecKennedy @DrOzCMS @CMSGov @HHSGov @GOPDoctors @GOPHELP @WaysandMeansGOP