Agreed. No matter what games you play with insurance exchanges and mandates, that's just shuffling paper around the problem of uncontained costs.

I think a couple of things that can be done right away is to make a law about what is universal requirement for basic health care. Currently, insurance companies are required to cover things that are medically necessary to correct problems that impact enjoyment of a normal life (I don't recall the exact language). But courts have ruled that includes fertility treatments and the often million dollar multiple births they entail, for example. I think the Obama administration was also pressing for gender reassignment surgery. While these are important, they are not actual life-or-death-or-health situations. While it may seem cruel to exclude those things, on the other hand, we have people actually dying or living crippled, due to the cost of health insurance.

And people who don't make good faith attempts to follow lifestyle disease prescriptions, like diet and exercise plans for obesity, should have reduced or no payouts, or have to take high risk premium plans. Obesity is one of the top factors of death and disease in America. The CDC calls it an epidemic. Yet for many it's a lifestyle choice.

A really basic universal set of required health care for employer plans should include basic coverage for organic diseases, accidents, infectious disease, conditions that are physically or mentally debilitating, and other things beyond your control. And then a more elaborate layer of coverage should be available to people who want lifestyle related medical services.

It just seems that, if some people can't afford health insurance, to have so much of health insurance premium in our risk pools being paid out for medical services for lifestyle choices, that's not fair or humane. I would prefer to be in a risk pool with people like myself who really are health conscious and take care of themselves, and not part of our lifestyle health care culture.