Healthcare spending has actually slowed down this last decade compared to previous decades. A market based solution can't work for insurance because it's an inelastic demand product with vastly different costs depending on the individual. Competition in the insurance market doesn't matter if you're someone nobody wants to insure. There's a reason we have Medicare. Nobody would willingly insure a very large portion of the elderly. There's no profit in it. The same goes for millions of Americans with preexisting conditions they have no control over. Type 1 diabetes, cerebral palsy, down syndrome, cystic fibrosis, epilepsy, sickle cell, etc etc. Premiums for these people would either be unaffordable or not even offered. I work in medical billing and more specifically I code ICU notes. Even now I see a dozen or more type 1 diabetics come in every week with ketoacidosis because they couldn't afford their insulin.