#1: the cost of develping drugs pushes the cost before insurance to ridiculous heights; and the cost of various large lawsuits, which eventually gets pushed to the consumer, driving the cost of most prescription drugs up even further;
#2: most insurance is paid for by employers, who, even though they can't absorb the entire premium, the part they do pay for hurts their profit margin and thus their viability to do business - besides for salary, benefits (including insurance) are the number one cost of doing business - in fact, at the low end of the salary scale, insurance may actually cost more than the salary itself;
#3: the cost of graduating from medical school forces most doctors to prescribe expensive, non-generic drugs in a form of kickback from Big Pharma in the doctors' attempt to pay off their tuition debts and student loans, which drives the cost of medication up in general and the cost of insurance up specifically;
#4: the cost of Government-regulated paperwork (which eats up productivity by forcing doctors to spend more time processing it that actually practising medicine);
#5: the high incident of Counterfeit medicine which raises the operating costs of drug distributors, who then must raise their wholesale costs to the Pharmacies in order to make up the shortfall, which is then passed on to the consumer (translate - to the Boss paying most of the benefits);
#6: the lack of a unified approach in the Government to solve this problem caused by political fighting, which is made all the worse by the undocumented illegal aliens who never seem to have a problem getting whatever they want while you and I must take a back seat in this whole process and watch as the whole system gets bankrupted by the illegals while we wait for people of courage to step up to the plate and fix it once and for all;
#7: the huge cost of new diagnostic equipment that causes the Lab companies to charge so much that many conditions are excluded because the Insurance companies themselves would go out of business if they had to cover all procedures based on need;
#8: most new jobs are created by small business, half of which fail in the first two years of their life, making it difficult for them to be able to earn enough profit to actually cover insurance without causing a more swift demise, and, eventually, a possible Depression in this country.
Other than that, it's a piece of cake, really!