It has to come from regulation at congressional levels. Value pricing, laws against dr reimbursement, & giving ICER the legal ability to do that would help. But also ICER is entrenched with gerrymandering & lobbyists so we need to set laws at all levels preventing gifts and favors. Then rework ICER. It can be done but we have to think about the necessary steps at all points in the process to get us from A to B. Far too many are getting bogged down in the details, making it seem impossible