[ljcn]

Perhaps the total volume is higher, but this doesn't lead to downwards price pressure since there are many small(ish) buyers.

The opposite is often said for the NHS in the UK - certainly a smaller buyer than the US aggregate, but maybe a larger player than any one of them?

[testpostpls]

Blue Cross Blue Shield buys for 100 million patients. How much bigger does it need to get to save money?