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international peers): $25.0B/year Issue #3 : Hospital Commercial Reference Pricing: $73.0B/year Issue #4 : PBM Reform: $30.0B/year Issue #5 : Administrative Waste (hospital operational variance, multi-payer billing complexity, prior authorization): $200.0B/year Issue #6 : Hospital Supply Waste (within-peer operational variance, case-mix adjusted): $28.0B/year Issue #7 : GLP-1 Pricing (price reduction opportunity from US-international alignment + generic entry): $40.0B/year Running total: $396.6 billion per year, 13.2% of the $3 trillion annual gap between US and Japanese per-capita healthcare spending