The United States spends nearly 18 percent of its GDP on health care. The next biggest spender among comparably wealthy nations pays about half that. And yet from life expectancy to infant mortality, American health outcomes lag behind.

So if we aren’t paying for better health, what are we paying for? Increasingly the answer is: whatever pharmaceutical and medical supply companies are selling, at whatever price they demand. A new paper published by the Journal of the American Medical Association finds that the reason the US spends so much on health care is because our medical prices and administrative costs are through the roof — “medical prices” in this case meaning the amount charged by corporations for drugs and equipment.

The US is one of the only nations that doesn’t regulate drug and supply prices. Companies negotiate contracts directly with hospitals and insurance providers, and these private contracts dictate the terms of our health care spending. The result is a health care system oriented around corporate profit instead of patient need.