The only problem with allowing market forces to take over, is that they truly can't until insurance can be sold over state lines.
As I'm sure you already know, the trouble with this is that each state will have different rules. States that aren't advantageous to insurers will find themselves without any.
Highmark controls 60% of the market share.
UPMC controls 30%.
EVERY other health insurance carrier controls the remaining 10%.
UPMC and Highmark also have locks on many of the hospitals through contracts and their "provider network"
If you don't have insurance through one of the big 2 companies, you can pretty much forget about going to most doctors or hospitals.
This is another odd quirk of America. Somehow we have a need to consolidate. Everything is centralized to a few powers. The easiest and quickest example is the power industry. Everything comes from some massive plant. If we decentralized power, we would save a ton of money and produce less pollution.
Employer paid care has two really big problems 1. shields the costs from the consumer (I'm rare in that I pay my entire insurance out of my own pocket, most just get what their employer gives them) 2. that insurance isn't transferable. Get laid off, sorry pal, sign for "cobra" and deal with that headache while you search for a new job (and who knows what their plan will be... or if they have a plan)
I would amend 1 a bit to say that the receivers of care have no knowledge of cost, but agree in principle. Also, cost is not the only thing employer based care shields consumers from. As with most industries in America, there is only an illusion of choice when your health care comes from your employer.
The issue is how the hell did it get that high to start (and this doesn't count the stuff that WAS included, which guessing would be at least that much). It's ridiculous. No other country on the planet has prices anywhere near that.
And why is that?
While this particular hospital is state of the art (and currently treating multiple gun shot victims ATM BTW) there's no way you can tell me that there aren't hospitals around the world that are just as or close to the same expertise and quality.... and yet, I'm guessing the pricing would be, half or a quarter the amount at the most? Why?
There's no one reason, it's a bunch of reasons.
You're right that there's no one reason, but I think what drives all of those reasons is that here in America it is a business like any other. There's no difference really between health care and sodas, as n0whereman pointed out earlier. Once you treat it like any other business, then it just becomes about interests. And then those interests, as you point out, get to write the bills and shape the policy. Instead of trying to find this or that reason and this or that solution, we need to throw the whole thing over. I cannot for the life of me figure out why Americans feel like our unalienable right to life should be based on profit motives. Everywhere else in the first world has figured out a way, some with government, some with a mix of government and business, to base health care instead on the right to life.
This bill we've gotten is not an overhaul, despite that word being used to describe it. We need a real overhaul.