For our fourth episode of season two, we were joined by Deb Gordon, author of “The Health Care Consumer’s Manifesto.” Deb is a former health plan executive, an Aspen Institute Health Innovators Fellow, and a former Senior Fellow at the Harvard Kennedy School.

Deb was a 2013 Eisenhower Fellow when she traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems, and how those learnings can make healthcare consumerism a reality in America. Her research into healthcare consumerism -- in search of consumer-driven solutions to American healthcare woes --  spawned her book.

Our hosts for this episode, Steven Cutbirth and Haden Marrs, sat down with Deb to discuss healthcare consumerism, price transparency, and the structural barriers that exist in healthcare.You can listen to the whole episode here or on Spotify, Apple Podcasts, or wherever else you listen to podcasts. If you’re short on time, we’ve included a few highlights from our conversation below:‍

Steven: “In 2013 you traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems. What was that experience like? What were some of your biggest findings in what made their systems successful?‍

Deb: “At the time I went, people often asked, ‘Can millions of Americans actually buy their own health insurance?’ And after my experience, I said ‘Yes, I think they can.’ Because, here's an example of a country. Australia is not so dissimilar to us and they do it there. Same number of people, but they do have a much smaller population. I thought, ‘What are they doing? And what is the impact?’ I think the biggest impact is that the citizens and residents of those countries are very, very aware that healthcare spending and access to healthcare is a shared responsibility. A hundred percent of the people I met in Australia, in particular, would ask me something like this: ‘So Obamacare, it's a big deal there. Why? Like what's the big fuss about? It doesn't even solve your whole problem.’ Like we took an incremental step to cover a portion of our uninsured and the people in Australia just look at me like, ‘You represent this horribly cruel and callous place that you've left still 20 million or whatever it is like millions of people uncovered and you're having a big to-do about it.’ You're having a big political fuss over something that doesn't even solve your whole problem.”‍

Haden: “So going from kind of wanting to really listen to consumers understand how you interact with healthcare, what really fits their needs, spending time doing research on that, kind of based off of everything that you've found, why do you think that as Americans we don't shop for care or at least aren't very good at doing that?”‍

Deb: “I think there are a few factors, but the short answer is the system is not set up for consumers to shop. It has grown up around institutions, around hospitals and providers, employers, and insurers. The roots of our system, at least the modern-day version of our system, really did not put the consumer at the center. And the consumer was not paying most of the bill. The consumer was not really the customer. So the system grew up around those entities that were really paying. So that's one. It's not designed for us to shop. I would call those structural barriers. Because, why would we publish prices? Prices are a function of a negotiated rate between an insurer and an employer, a provider and an insurer. And so there's no sort of role for the consumer in that equation. That's how it was for many decades; just as one kind of obvious example of a structural barrier to consumerism. But I also think we are to blame. Not to blame the victim, but you know we as consumers, as Americans, definitely know how to shop. We know what to do when we're spending our own money in healthcare. I think we haven't until much more recently recognized that the money spent in healthcare on our behalf is actually our money. It's now literally our money coming out of our pockets, but it's also our taxes, our compensations in lieu of wages we're getting health benefits for those of us who get our insurance through an employer. So there's been a mindset shift or an attitudinal block that leaves consumers not confused, but just sort of, not really aware. Not really thinking of healthcare spending as our money. So it's sort of structural and individual barriers to consumerism."

To hear the whole conversation, click here for the full podcast episode. You can also see more from Deb by visiting Forbes.com and follow her on Twitter.