I have been in medicine since 1990. I have held leadership roles in major hospitals and have a private surgical practice. Healthcare reform starts by mandating publicly traded for profit insurance companies be banned. Their duties are profit for shareholders in their current form. Mutualize all of them and incentivize them by being efficient in their administration of services- cut most of the employees and use 90% + of funds for healthcare. More efficient companies will get more consumers to sign up. Savings at year end gets delivered back to the members (insured) as a dividend. This reduces member out of pocket costs. People can opt in or out of things they do not need to cut costs. Incentivize members with discounts for living healthier. Pubic healthcare does not work (I treat Canadians all of the time who cannot get elective care). I currently do not accept insurance but treat my patients fairly and with highest levels of expertise and it works and is not cost prohibitive. Punish docs/hospitals for price gouging. Force hospitals to be fully transparent at time of care. There are many ways to solve this problem but the first is to ban publicly traded Health insurance companies
You can’t run an insurance company on 10% without major changes to regulations such as HIPAA, state-level mandated benefits, ERISA exemptions, etc. The significant spiraling cost drivers are all on the provider side. How many times in your career have you run across Sister Whoever of a non-profit charitable hospital system reciting “no margin, no mission”? 
I would say the first step in meaningful health financing reform is transparency in pricing. Medicare payment levels generally don’t reflect the cost of the underlying procedure performed. So, you have a massive cost shift by providers to Commercial lines of business to cover losses on the Medicare lines. Though it doesn’t solve the problem, Medicare reimbursement at more cost-based amounts to bring down Commercial rates would be a start. Then we can figure out based on true costs, what are the ways to make healthcare services more affordable.
Agreed. Healthcare needs to be in the hands of doctors, not insurance companies. I worked in a cardiology office for 6 years. It is ridiculous the hoops you have to jump thru to get patients the meds and treatments needed. Insurance is all about profit and not paying for anything