There are a multitude of reasons as to why American healthcare has gotten so expensive; technology, demand, aging populations, regulations, overhead, malpractice and defensive medicine, etc., etc.. But the major reason for the burgeoning costs in my opinion has been the proliferation of these third party payer groups. I mean, it's common sense. When folks spend their own money they are far more careful with it (you wouldn't, for example, go to the emergency room for a head cold and spend a thousand dollars) and, yes, because of that, a) the demand goes down and b) providers of these services are actually forced to compete for your business.........................................................................And, yes, folks, there is an abundant amount of evidence to substantiate this; a) the fact that the noninsurance sectors of the American healthcare economy (lasik eye surgery, plastic surgery, full body scans) have consistently been going down (in the case of lasik eye surgery by as much as 80% in certain areas), b) the fact that the people of Singapore pay for the bulk of their healthcare with out of pocket cash and the costs there are 80% less there than in America, c) the fact that the corporation, Whole Foods, has largely gone to a plan in which personal health savings accounts (supplemented by a high deductible policy) are featured and costs have gone down markedly, d) the fact that the state of Indiana has also gone to a plan (for their state employees) in which health savings accounts are featured and their costs have gone down significantly and with no negative change in outcomes, e) the fact that healthcare spending in the U.S. was but a tiny percentage of overall GDP right up to the start of Medicare and Medicaid and then it majorly started to skyrocket. Again, it's just good old common sense here. You get rid of the middle-man and you save yourself a boat-load of money.