When I managed benefits for my company (with 1400 employees) I saw why our premiums increased each year. The insurance companies basically gave us a breakdown of the high cost claims for the previous year as well as the population health data. If our employee pool went from 40% obese to 44% obese, guess what? Our insurance premiums went up. A NICU baby and a kidney transplant, and our premiums went up (in one year 5% of our 8% increase was directly attributed to one premature birth and one kidney disease... both for spouses of employees...). Alternatively, when we implemented a wellness program and saw across the board blood pressure and weight decreasing, our premiums actually went down (5% decrease the year after I started a wellness program).
Insurance is expensive because 34.9% of America is obese, 50% of Americans have diabetes or are pre-diabetic, and folks keep getting older. Americans keep getting more obese, more ill, and older. Young adults have babies and 10% of those are preterm. Insurance has to lump all the costs together, add overhead, and still make a profit. The ACA told insurance companies that they not only had to insure the 45 year old, diabetic, obese person, but they also couldn't charge them any more than the 45 year old in perfect health! That really screws with your cost formulas as an insurance company.
The other thing I saw (since I worked in healthcare) was that our costs were hugely impacted by the 30% of our patients who didn't pay a dime. It only has gotten worse with all the high-deductible insurance plans. Those with high deductibles often didn't pay at all either. Say they had an emergency room visit that cost $3000. Their deductible is $3500. The insurance didn't pay us, and the patient never does either. But the law says we have to treat them regardless of their ability to pay. Now, guess why the hospital has to charge so much to those few people who can pay (or their insurance companies, more likely).
From a healthcare system point-of-view, a single-payor system would be one way to lower costs for everyone. Simply because there is such a high percentage of folks who don't pay at all, and the costs are absorbed by those who do. The other way to significantly lower costs for everyone would be if Americans went on a diet, increased exercise significantly, and started meditating regularly.
It may not be fair to the young, healthy, slender male American to have to pay high healthcare costs. It sure isn't fair to everyone else to be denied insurance (a few years before the ACA I was denied a private insurance policy due to a previous yeast infection. Seriously!). It isn't fair to a hospital that they have to treat the kid with the ear infection in the ER and get stiffed the bill by the parents, because the parents can't go to the pediatrician since they haven't paid her... And it really isn't fair that employers get stuck with really high insurance costs because their employees sit on their tushes all day munching on donuts and getting stressed out by incompetent managers... oh, wait. Maybe that one is deserved... ;)
