I am going to start by saying I work for the largest insurance company in the US, and these thoughts are mine, and in no way endorsed by them. 1. Ya, well, prices aren't going up because of insurance companies. We take the costs, mark them up, and pass them on. costs are going up because people are living longer, drug costs are going up, and providers (docs and hospitals) have no interest in controlling costs at all as they consolidate and drive up the cost of care (they also have to pay for all that fancy equipment they buy). Seriously, yes, we make a bleep ton of money, but we make it by marking up escalating costs, not by escalating the costs. 2. Yes, if you cut insurance companies out, you'd cut some profit out. But, hey, MN only allows non-profit insurers (irony, given who is HQ there and supplies yuge numbers of jobs there), are the costs there any lower than neighboring states? I think not. Why? Because all insurance companies do is mark up the rising cost of care for a profit. While that might seem wrong/bad/evil, we do offer some important services (especially to those that don't get much healthcare, and done come from a background where it was important), and while I don't love all of what we do, I think we do add value. 3. Selling across state lines is nonsense. There are huge barriers to entry in insurance, there just aren't that many (any?) companies out there that don't sell where they want to sell. Also, since the states regulate the benefits in plans, how would that work? Can insurers that cross ignore those? If not, then it is just, um, nothing. States will let anyone that is solvent sell in their state, as long as they provide legal benefits (nearly anyone, I used to be in regulation). I would endorse the following, until we can get single payer: a. Universal catastrophic insurance, pick a threshold, the government sponsored insurance pays it all. b: An account is created the day you are born (if already alive, it phases in for all of us over time) where the government puts 2-5K a year. That money is invested in the markets, and you can use it to cover education and medical expenses only (until some later time, when you can take out some profit but not principle). This is funded by cutting out various subsidies (including medicaid and medicare over time, but mostly for companies). I ran the numbers on this 30 or so year ago, and it worked then. Given our love of corporate welfare, it probably works even better now. c: Even under this or single payer, there will be private insurance. People will want more. Also, a company like ours will probably run parts of the system. This stuff is infinitely more complex than most anyone can imagine.