Lots of regulations. Lots of reforms. Public financing in a market system in a time of privatization. This increases the pressure on employers and the public. Everybody can't shift costs to everybody at the same time.
Markets can only measure access and quality by market calculus.
Access is determined by who can pay. E.g. uninsured children can be covered only if there are new government funds. HMO's measure access through market share. Quality is defined as what sells. Radio ads for prostate procedures.