"Right now, there is a capitalistic force to try to keep costs low, in order to be competitive."
Insurance companies add up the costs. Divide by the number insured. Wiggle amounts by risk. Add administrative fees.
If costs of healthcare go up, they get passed over in higher premiums.
Yes, there is also some price negotiation by private insurers.
Medicare has limits on what they pay as well.
The ACA put an admin limit of 20%. Insurers must send rebates beyond that.
I do think the insurance industry needs to stay involved.
They could subcontract Blue Cross the way they subcontract Boeing.
There are options to look at.