Any collection of savings is a great temptation for fraud or embezzlement by the person(s) having fiduciary responsibility.  That's why insurances companies and banks have been regulated in most states, and banks regulated at the federal level.  Without regulation, failures of fiduciary responsibility can destroy the industry by driving away folks seeking to save or insure against risk.  So you have lots of legal ways of sucking cash out of the same cash cows; essentially these days by nickel-and-diming savers through service charges, co-pays, overdraft charges, deductibles, access rules (transaction are not posted until the next business day), precertifications, exclusions of certain conditions, and so on.  I conflate banks and insurance companies here because the regulatory problems arise for similar reasons and the strategies for non-payment have parallels.

So knowing that regulation ensures the market, both banks and insurance companies would rather be regulated by states, where lobbying costs are cheaper and public outrage is more diluted.

But saving for healthcare risks is not the only model for providing healthcare.  It looks sensible to our individualistic, personal responsibility flogging culture.  Risks could be pooled over the entire society and services financed out of general taxation and provided by government employees (UK) or paid to providers by the government (Canada).  The government could use general revenues or special taxes to pay for services to certain classes of individuals - old, disabled, poor, veterans, public employees - and in some cases acting as the payer of last resort (US).  And these classes of people too often pay for healthcare by lost time waiting for hours in a clinic.  Or through indignity.

Fact is, markets are a way of rationing scarce goods and services on the basis of ability to pay.  They never can cover everyone.  If you want everybody to receive some service (vaccination, say, or education, or fire protection), markets are not the best way to deliver those services.

Those employers who don't want to give up providing healthcare benefits do so because it is a nonfinancial way of handcuffing workers to below average salaries.  The story is that healthcare leverages the services that additional salary could buy because of the difference between group and individual premiums.  As employers cherry-pick workers based on healthcare records (employer self-insurance should rightly be seen as an invasion of privacy), these distinctions matter less.  The fact that Congress is not facing is that given the volatility in the labor market and the number of temporary and contract jobs, employer-based health insurance no longer works for anyone.  And COBRA has proven to be just a big snakebite.

50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

Therefore, the only way to make a profit is to deny someone a needed & deserved payout.

"But I will not let myself be reduced to silence."

timothy noah had an interesting piece in slate last week regarding employer-based health insurance, wherein he posits that "Employer-based health insurance is dying...."The Paradox of Health Reform*

one interesting factoid in it is this:

...Polls tend to show that while a significant majority of Americans favors a more aggressive role for government in controlling health care costs and extending coverage to the uninsured, a [narrow] majority simultaneously pronounces itself satisfied with its own health insurance, which typically is provided by employers. A March poll conducted by CNN found an overwhelming majority (77 percent to 23 percent) dissatisfied with the health care costs borne by the country as a whole, but also found a narrow majority (52 percent to 48 percent) satisfied with the total cost of its own health care. It's a baffling but not unusual discrepancy. As journalist David Whitman noted in his 1998 book The Optimism Gap, Americans tend to take an unrealistically sunny view of their own circumstances compared with those of other people...

as one of the comments said, one could look at the 52 - 48% number and just as reasonable interpret it as nearly have the people with employer health ins. are dissatisfied with it, not a particularly positive sign either way, imo.

additionally, he quotes economist uwe reinhardts' article from the nyt's economix blog:

...reasons employer-based coverage doesn't work very well:

1.  If you lose your job, you lose your health insurance.

2.  Having the company choose the insurer for its employees and then share the costs muddies the whole question of who pays and whether a given policy delivers good value. According to Reinhardt, over the long run, the company recovers its investment in the form of lower take-home pay for its employees, but employers tend not to recognize this and, instead, believe that they are competing on an unequal footing with counterparts in countries like Canada, Denmark, the United Kingdom, Italy, and Spain, where government picks up the entire health care tab.

3.  Because premiums are "experience rated" based on the health histories of a given company's employees, one serious illness can drive costs up so high that health insurance becomes unaffordable, especially for smaller companies.

l would also point out the pay to play option, as l currently understand it, exempts small businesses who employ fewer than 25 people...which is by and large, one of the groups hardest hit by the rising costs of health insurance/care.

it's a worthwhile read.

the revolution will not be televised...

Paid in full by the insurance company. Thank God.