People want managed health care under the guise of insurance. Actual insurance is to cover the costs of something you expect to *not* happen, but don't want to be wiped out by. And proper use of insurance is with a high deductible. You can handle $30,000 if you have a serious health problem, with insurance covering hundreds of thousands of costs. If you want a really low deductible, you're paying far more over time, or are planning on using your insurance regularly, in which case you're scamming them or wanting the impossible. This is not to say that there is corruption in insurance companies, but even if that weren't present people want the impossible from insurance. The managed health care they want makes someone else pay, which makes the consumer insensitive to the cost of where they go or how they take care of their health, so the costs go up. Throw in the bullshit of not being able to charge sickly people more, especially having to cover pre-existing conditions, and you put the costs through the roof, where people sign up only when they need care.