A hallmark of health policy is that even simple fixes are hard to implement. To illustrate, it has taken years of legislative battles for the US House of Representatives to pass the Lower Costs, More Transparency bill,1 which aims to equalize Medicare drug payments to outpatient medical facilities regardless of ownership—a move toward so-called site-neutral payment policies. Despite the overwhelming bipartisan vote in the House (the bill passed with 320 votes to 71) and the US Congressional Budget Office’s estimate that site-neutral drug payments would save more than $3.7 billion over 10 years, the bill’s enactment by the US Senate remains uncertain because of aggressive lobbying from hospital interests.

Richman BD, Plummer E, Bai G. The Curious Persistence of Site-Dependent Payments. JAMA Health Forum. 2024;5(11):e243616. doi:10.1001/jamahealthforum.2024.3616