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Can someone explain to me simply (and I'm assuming the answer to that is "no"), why they can't force the insurance companies to compete with each other on price. That would seem to be the obvious "free market republican" thing to do, and a prerequisite for removing the fat subsidy to the insurance companies that they're currently trying to remove.
So insurance companies have to pay back out to their insured 85% of all money they collect each year. Been that way since the 1970's.
What this means is that they WANT medical costs to be as high as possible. 15% of a $2,000 ambulance ride is a lot more than 15% of a $500 ambulance ride.
So the insurance companies have spent decades forcing hospitals to increase costs (charge more or we'll make your hospital out of our network and no one will come to your hospital).
What this means is that as long as insurance companies exist, there isn't really a "compete on costs" possibility. They're already paying back out 85%. At most they might be able to make things 5% cheaper. There's no competition because there's no real areas to cut costs, by design.
The only fix is to eliminate insurance all together and go single payer, or to legally force hospitals to drop all their billing costs down to levels on par with the rest of the world, and both those options will be fought tooth and nail by insurance companies, since one would make their business disappear and the later would make their 15% cut for profits and overhead vastly smaller.
Another factor is that insurance companies make money on the "float", meaning that they invest the premiums and keep the returns before paying out on claims. In times where rates of return on investment are high, they can be profitable overall even if claim payouts are larger than premiums collected. If medical costs are high then so are premiums and they make even more money off the float.