@User it is true that you could have external PA and matching but there are plenty of applications where you want to hookup directly to an antenna, wifi, bluetooth etc. in which case ohms law puts a constraint on power/impedance. This video is a perfect summation: Of course you're not going to be putting 10's watts through a process like this - although you may be able to if you handle your thermals and metalisation properly and you're happy to use a lot of area. But the 1.8 V devices with no transformer would provide much less flexibility. Luckily we've got these 20 V devices + layers with good inductor properties to explore