Today you can still call around and get a doctor's appointment with no insurance and the average price of that visit is $160.
I have been on 100% government funded/ provided healthcare for most of the past 44 years. For 20 years I was in the US Navy - a fully government owned, government run medical system. It was mostly satisfactory. I couldn't choose my own doctor, my own primary healthcare provider, which hospital I went to - all the horrors people describe as the worst things about government run healthcare. I've seen mostly very good healthcare providers - but like any system there were some people who should not have been there.
From 1992-1999, my healthcare 'insurance' was Champus and Tricare - military retiree insurance provided by the government. It functions much like Medicare - but fewer doctors will accept assignment. Living in an area with relatively few military retirees - I was on a cash pay basis for medical care most of that time. (Big corporate hospital companies did accept assignment of Tricare).
From 1999-2009, my healthcare insurance was Aetna and United Healthcare through a Fortune 100 employer. It was almost as restrictive as to what doctors I could see, what hospitals I could use, what drugs I could take - as being in the military. I found it no greater 'freedom' to choose my healthcare providers than in the past. Nor could I negotiate any prices. In 2001 I had a major medical illness. The total hospital and doctor bills for the nine month episode and treatment were a bit over $450,000. My primary health insurance paid about $320,000. Tricare as a supplement paid about $60,000. I was placed on short-term disability for four months by my company - 50% of my salary - which resulted after paying health insurance, social security, income tax in a net $135.00 every two weeks. The company did allow me to come back to work a limited schedule at full pay. I had to pay about $80,000 on a gross salary that year of $53,000.
I'm not complaining about the insurance and the coverage. I got the treatment I needed to save my life. It just took all my savings and my wife's savings to stay above water that year, and after borrowing money to meet payment demands - five years to pay everything off. The $80,000 cost me close to $102,000 when everything was finished. At least I didn't have to worry about losing my job because I was sick. It was that type of company at the time.
After early 2009 - I'm back to Tricare, and go on Medicare in a year. (My wife is already on Medicare.)
Thanks to the efforts of a couple senators who pushed some legislation through Congress in 2002, Tricare now has to be accepted by any doctor, hospital, etc which accepts Medicare. John McCain proposed the legislation when so many reservists were called up for service in preparation for Iraq, and their families were being left with medical insurance coverage that local doctors would not accept.
He needed a partner to get the legislation through the Senate - and he turned to a Senator with great experience and expertise in healthcare - Hillary Clinton. Together they pushed the bill through the Senate, and got their party behind the bill in the House.
Tricare is a 'single payer' system - though the country is divided into four or five regions and each region has a different insurance company running the claims and payments division. It used to be UHC for my region, right now it is Humana. (Prescriptions are covered under a nationwide contract - used to be Medco until Express Scripts bought them.)
However, that has left me with my endocrinologist who does not accept my insurance. Since he is the only one who figured out my real issues and how to control them back in 2001 - I pay his $225 per visit - which is about half what he used to bill my insurance company. The part which bothers me is that he used to receive about $200 from UHC when I had that insurance.
I did engage in competitive price shopping for medical services this year. I decided that getting my teeth pulled and dentures made in Mexico was significantly cheaper than in the US - at least 60% cheaper than any price I found in the US. I had cataract surgery on both eyes this summer. That was mostly covered by Tricare. I did pay for a supplemental LRI procedure on each eye which eliminated my astigmatism. We were very price conscious when shopping for hearing aids for my wife, but did choose a higher cost brand for the quality. (My hearing aids are supplied/ covered by the VA because of damage to my ears from working around jet engines, two major concussions received in the line of duty, one while fire fighting, the other on Oct 23, 1983 in Beirut.)
That is just to establish my background in healthcare and understanding of the process..
Selling insurance across state lines - this is a primary goal of the Bill Clinton and Democrat Party health care plans/ goals. It was stopped from being included in ACA / Obamacare by the conservatives/ Republican Party. Mandating at the federal level that insurance has to be transportable across state lines is viewed by the conservative/ Republican Party as federal interference in States Rights. Just within the past two months - Texas Governor Greg Abbot was speaking against the ACA - saying the state insurance commission must be able to control what insurance is sold in the state. If there is nationwide coverage and competition for policies - that will result in the people of Texas being forced to accept lower quality insurance for higher prices.
One of the 'good' things about the ACA/ Obamacare is the exchanges. No they don't function extremely well. However they do allow a person to search ONE website and see the prices of several different companies side by side.
Compare that to the situation with Medicare Supplements (a system of national health care forced on the population by President Bush's 2003 changes that allowed companies to dump retirees from their healthcare plans on Medicare).
I just came from a weeklong gathering of RVers - mostly retirees - in Oklahoma. It was interesting to hear the longer term retirees complaining about how their healthcare coverage and options went downhill in 2004-5-6. How the mid-term retirees who have always had to deal with supplements - and the new to Medicare people complaining that the Medicare Supplement was "A worse mess than Obamacare - at least there I could compare plans side by side".
But even then - the supplement plans have state by state variations.
Competition in medical care costs will never meet the goals of people seeking to reduce price in the US:
1) Medical Insurance will always be a monopolistic system in the US - with definite collusion between the companies about rates and coverages. They wrote most of the ACA - and got what they wanted mostly. Even if policies are sold across state lines - the goal of insurance will remain the same - to make profits for the insurance company.
2) Major hospital systems will always have a take it or leave it policy. This country has long needed public hospitals - government run with government employees - to cover those with limited means. Parkland in Dallas is a government owned, government run, government employee hospital. Many of the very best hospitals in this nation are city, county, state supported institutions. Other major healthcare systems run by religious groups function in the same basic way. As long as those hospitals exist - the corporate for-profit hospitals do not have to modify their pricing, services, system to deal with 'low value' customers. (Though I'm a bit concerned at a trend in Texas to turn long running religious supported hospitals into 'for profit' corporations.)
3) Prescriptions - as long as conservative/ Republican members of Congress and liberal/Democrat members of Congress accept money from drug companies for campaign donations (Citizens United was a victory for the drug companies) we will never have competition in the US for prescription prices. There will be outrage at issues such as the recent one over the EpiPen. But no real change. (There already existed several good, much cheaper options to the EpiPen - people just didn't want the 'inconvenience'). Donald Trump cannot change the bought and paid for Congress insistence on protecting the drug companies in the US from price competition across national borders. (Yes, I do buy some of my drugs in Mexico at substantially reduced prices. No, I cannot buy any narcotic type drug and bring it back. But I can get Metformin at 1/3 the US pharmacy price.)
(Side note - getting old S***KS - I never ever considered spending as much money - either actual dollars or percentage of income/cash - on illegal drugs when I was young as I now have to spend on prescription drugs.)
4) Point of Sale - this is the only real competition possible in the US - as I said above - reducing the amount of money your individual doctor receives. To most people doctors are like Congressmen. We complain about their costs, their way of doing business, etc. We listen to them complain about over regulation, forms and such. But at the end of the day - we don't want our doctor to be the one where the pressure to reduce prices falls.
I do sympathize that a doctor's office has to understand between 15 and 20 different forms/ submission systems - a different one for each insurance company. At least Medicare/Tricare are single electronic submission - single payer systems. Single payer is a great advantage for a healthcare provider.
No matter what he says, Donald Trump cannot change three of the four major sources of healthcare in the US. His party opposed any changes to the big three - and he won't get the support he needs to make any real changes.
As I said above and many times, Trump does not demonstrate a knowledge of how limited his power to actually make decisions and implement them will be as President.
Notice that Hillary always says "We will work to ....." and Donald says "I will do ....."
Side Note #2 - I do find it dismaying that people do not realize that they will never have healthcare that they do not pay for. If the company pays it, you accept lower wages and restrictions on what coverage you can have and where you can go. That is what we accepted serving in the US Navy/ military. That is what I accepted working for a major US based international corporation. If the government pays for healthcare - you pay for it in taxes.
Health insurance only spreads the risks across a wide group of people. Most of the people must get less service than the premiums they pay for an insurance company to stay in business. When we were/ are young and healthy - we pay a lot more than we 'use' - so that when we are old, the insurance will be there when we need it.
Health care is never free. All insurance does is provide a bureaucratic layer to take 40-60% of the money paid for healthcare and divert it to support that administrative function (which includes profits for investors) rather than transferring the money to the healthcare providers.
It doesn't matter if the bureaucracy is government or a private corporation - the costs and 'efficiencies' are the same.