Yes, there is a great success story in Medicare, but Medicare claims have been administered by private companies, not the government, from the outset. There's a lot of crossover he didn't talk about.

There is the whole concept of fee-for-service. Doctors only get paid if a service is provided, so the incentive is provide services. Doctors aren't evil, but there are documented instances of unnecessary levels of service being provided (the US used to have the highest number of cesarians in the world, for example, but prenatal care was at an all time low).

There is a problem with cost-shifting, but here's the thing: some of that is reduce payments for medical services the public insists on, but aren't either medical or necessary. Not to over play the hand, but these do exist. Some of it is to protect profits, but necessarily for the insurance company. It protects drug companies, and the employers who pay the premium. And hospital corporations who are increasingly pressured to show a bottom line.

And then there's the whole back end thing. Going to an ER because you don't have a doctor, either because you don't have insurance, or you just don't have a doctor.

The insurance industry isn't a saintly institution by any means, but neither are they the complete demon in all this. The medical care inflation index has a lot more factors contributing than most people understand.

The thing is though, the industry is used to making reforms when those are passed on a state level (the only current effective regulator) and enforced. They have to be told, and they have to receive consequences.

But expanding the pool of insured persons will reduce the costs. It eliminates actuarial risk, a phenom in insurance when the people most at risk are the main ones who buy coverage because they know they need it, while the ones who will need it down the road don't buy until it's clear that they do.