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The American health care system is the most expensive in the world, and nearly half of Americans took at least one prescription drug in the past 30 days.

A new survey sponsored by the University of Utah Health suggests doctors aren’t to blame for skyrocketing health care costs. Instead, accountability for outsized bills and fees should fall, in large part, with the web of pharmaceutical and insurance companies. Regardless of which side of the health care industry one falls, more transparency and competition must thrive to provide Americans with affordable health care.

The survey, done with the help of the New England Journal of Medicine's Catalyst, is a commendable first step in the University of Utah Health’s mission to define the value of health care in America. Finding the true cost of administering care to patients may do much to suppress the rising tide of expensive drugs and procedures.

The results of the survey turn a common myth on its head. Physicians are often accused of being allied with pharmaceutical companies, and they are criticized for overprescribing medication and getting paid to encourage patients to take a specific drug brand. But the survey reveals doctors, executives and clinical leaders hold a perception of so-called Big Pharma similar to that of many patients, reporting that they “overwhelmingly believe pharmaceutical firms, followed closely by insurance companies, hospitals and health care systems, have the biggest impact on costs.”

It’s easy to lay the blame at someone else’s feet, especially when that someone is your competitor. University of Utah Health, for instance, may have a vested interest in promoting doctors while punishing big drug companies. As such, American patients need clearer information from all parties if lowering high costs is the end goal. But that also doesn't diminish Big Pharma’s role in driving up the price of drugs across the country.

The American health care system is the most expensive in the world, and nearly half of Americans took at least one prescription drug in the past 30 days. This burden is felt most acutely by those left with limited choices in a bungled system of insurance options, but it’s also an indictment on how medicated the country has become, driven in part by the interests of pharmaceutical companies that have massive market shares.

Reports describe how the trust-like powers of large pharmaceutical companies determine which drugs get tested, bury evidence of unwanted findings and vigorously promote certain medications. Commenting on these practices, Dr. Marcia Angell wrote in the New England Journal of Medicine, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”

This lack of transparency breaks down the trust between patients and their medical providers — a relationship that ought to be filled with support, confidence and reliability.

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For a first step toward a lasting fix, Americans must have a better understanding of why their health care costs are so high. That understanding begins with a critical engagement with the role of pharmaceutical companies in determining the quality and cost of American medical services — a public reckoning and scrutiny that must look beyond mediating physicians to uncover who is actually responsible for existing dysfunction. It also involves other industries within the health care world to bring their full transparent selves to the table. Pointing fingers at others means no one is pointing at a solution.

In a world of ballooning health care costs, shedding light on these practices is just what the doctor ordered.