I'll trade your anecdote for mine: I have been working for Decent Companies for 15 years. Every year my payments went up, the company's prices went up, my copayments went up, and my coverage went down.

The real nadir for coverage was in the end of the Bush years: I worked at Home Depot as a developer. That means that the plan covers a lot of badly paid people, and a lot of old people. I was paying hundreds a month, my doctor visits were $75, 20% coinsurance in hospital visits up to 10K, and a maximum lifetime benefit of 1 million: So if something really bad happened, like a stroke, they'd stop covering before it was all said and done!

Since, my payments kept going up at similar rates, but at least things like maximum lifetime coverage has gone away.

The one and only time things have dropped in price was last year, now that I work at a place where the average employee's age is 26. The company still pays $1600/mo for their side of the coverage, but since it's mostly developers, they can afford it. No company in their right mind will pay that when the employees are making $15/hr

Healthcare has been less and less affordable since the Clinton years, it's just that it started very affordable. the ACA didn't make things noticeably different for the good plans overall: It's all still very expensive, and picking an employer that either has a young, healthy workforce, or has so much money they can pay for expensive plans, is the big difference between having good health coverage or not.

So I guess that what I am trying to say is that if you had the insurance you claim to have had in the bush years, you were incredibly fortunate, and your situation was not common.

So what gets me is that people seem to think healthcare should cost less than $1000/person/year and I just can't see how that's reasonable. If anything remotely serious happens it will cost hundreds of thousands if not millions, and I just can't see how it's possible to cover that kind of situation when we know from our own lives that things like Diabetes, Cancer, Stroke, Heart Attack, and even Car Accidents and such are common enough.

I had childhood cancer and at the time it'd have costs millions without insurance.

While the healthcare market is hopeless opaque and corrupt and no doubt that does drive costs somewhat (or a lot), and probably there are things to do about it, but I think fundamentally the success of complex and expensive treatments is also driving costs - things that you'd have gotten painkillers and left to die even in '50s and '60s now can be cured/improved/fixed, it's just ridiculously expensive compared to popping some pills and expiring. Or look at prosthetics. There was a time you might have made do with crutches or a peg leg and now there are specially designed, fitted, and crafted prosthetics for various activities... that don't come cheap. Not to mention improvements to the standard of care or the sheer man-power requirements of health-care. A normal doctor's visit requires interaction with 3+ employees, across ~45 minutes, all of whom are presumably being payed more than $10 an hour, and possibly a lot more. It may actually be reasonable that budgeting $5k/person/year for healthcare is sane in terms of both risk and what you get, but just far more than people are used to thinking about or seems intuitively reasonable.

I think you hit the nail on the actual issue with health care in the USA. The problem is not as much insurance companies but medical providers' price-gouging.

Edit: sometimes it's a good idea to call ahead and ask for "uninsured quote", you would be surprised your $200/visit physician might only charge $50 to someone without insurance.

Sounds like your employer used ACA as an excuse to switch to cheaper plans and cover less of the costs. Are you sure you're laying blame on the right culprit here?

What I think your actually complaining about is High Deductible Health Plans and HSAs which came into law in 2003. It's just taken time for them proliferate.

The reason they are becoming popular is that they are intended to incentivize the consumer to pick and choose their providers since they have to bear the brunt of the initial cost. (And cheaper for employers to fund over non high deductible plans).

I recommend reading up on the history here: https://en.wikipedia.org/wiki/Health_savings_account

So... What are you saying?

For profit corporations will always find a way to game the system? Just like the whackamole with tax cheats?

That trying to regulate a broken marketplace doesn't work very well?

Perverse incentives lead to perverse behavior?

Forgot to mention FSA. Employers love them because unused money deducted from your paycheck (i.e. YOUR MONEY) goes back to them. I suggest you look into HSA accounts instead.