When Americans say they are worried about health care costs it’s mostly about premiums. That is what people see on a regular basis.
Why this matters. Most people can’t see the year to year value of their insurance- because they don’t use it to any extent.
One of the most striking statistics in healthcare is how skewed spending and usage are across the general population:
- The Top 5%: This small group of the population is responsible for nearly 50% of all healthcare spending. These are typically individuals with chronic conditions or those requiring intensive, acute care.
- The Top 1%: This group alone accounts for over 20% of total spending.
- The Lower 50%: Conversely, the healthiest half of the population accounts for only about 3% of total healthcare spending.
People over age 55 account for nearly half of all health spending, despite being roughly a quarter of the population.
Of course the drivers of premiums are prices and use of health care.
A system or non-system as in the United States which uses many multiple payment systems will never be able to control costs-ever- because any effort to control (costs) premiums for one payer is simply shifted to another.
QUINNSCOMMENTARY 
You state: “… Healthcare costs are a major concern for Americans, especially when it comes to premiums. A universal insurance system could address this issue by ensuring fair and transparent healthcare expenses for all. …”
However, universal insurance systems, like Medicare and Medicaid are fraught with fraud.
https://www.realclearinvestigations.com/articles/2026/03/24/citizen_sleuths_spotlight_red_flags_galore_in_government_spending_1172246.html?utm_source=substack&utm_medium=email
And, of course, if you seek “fair and transparent” treatment for all with health coverage, you can’t have Congress buying votes by setting Medicare and Medicaid reimbursement rates far below the actual cost to deliver services – prompting providers to raise prices for everyone else.
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