There are a number of related problems. 1. Doctor cartels (this one is sort of self-explanatory) and other provider coordination on pricing 2. Over expansion

There are a number of related problems. 1. Doctor cartels (this one is sort of self-explanatory) and other provider coordination on pricing 2. Over expansion of insurance (insurance is not meant to cover things that are expected, we have expanded insurance to cover routine expected expenses) and the associated costly administrative structure 3. Lack of price transparency 4. Global free ridership on drug prices makes us think we could get new drugs for much cheaper than we could 5. Lack of neutrality in tax law between cadillac health insurance plans and income 6. Overutilization (partially due to fear of malpractice lawsuits, partially due to overexpansion of insurance) 7. Political failure to address any of these. Obama tried to resolve 5 and Trump tried to resolve 3. Both have essentially failed. Almost all of these are caused by bad policy more so than the market-based outcome. This is not a ranked list, if I had to find primary culprits it would be 2, 3, and 6.