There are simple answers Health Insurance affordability in the US. Rationing. No NOT via a single payer system where some all-knowing official decides who does and does not get care. Rather, the rationing is done by the buyer. For example, Buyer one could decide to only buy a policy which covers only generic drugs, which would exclude all patented drugs (newer and even superior), Buyer 2 could decide to buy a policy which covers generic drugs and patented drugs in one or more specialties (e.g., cardiac). The theme is let the buyer decide, not everyone wants to live the last 10 years of their life struggling to regain their youth.