Congresses and presidents took a reasonably well-functioning and largely private health care delivery system and royally screwed it up. First came Medicare, allegedly instituted to provide insurance coverage to low-income seniors. Regulations trickled down from Washington, D.C., to rein in prices. More people dropped private insurance because they could no longer afford it, not only due to steeply higher prices but because disposable income dropped as taxes at all levels of government ate up ever-larger percentages of citizens' salaries. Plus, why pay insurance premiums when you can always glom onto government-provided coverage after you become sick or are injured.
Patients complain about costs and quality of care.
Doctors complain about paperwork, bureaucrats dictating treatment plans, and micro-management of their decisions. Insurance companies complain about mandates and lowered reimbursements from the feds and the states. So, of course, Congress and the Prez in their infinite ignorance create HMO's to reign in costs. De facto rationing results as managers focus more on cutting costs than providing treatments patients actually require. So our federal dunces demand insurance portability, insist that even more conditions be covered, and expect HMO's do more with lower payments.