I'll tell you the thing I really hate about insurance, especially health insurance. They make everybody else's costs go up.
So many plans negotiate rates on a % below normal that doctors and hospitals raise their rates to everyone else so that they can discount them to the insurance companies. I think that ought to be illegal. In fact, I'm not so sure it is not already in violation of some of the anti-trust laws.
My wife had surgery, The bill was something like $10,000, but the insurance company had negotiated a rate of $5,000. That means if we had decided to self-insure, we would have got stuck with a rate that was twice as high than if we had insurance. That is just WRONG!!!
My opinion, no group under 150 lives should self-insure. Gambling with your health and your financial security at the same time is unsound.
As for your second point, the new statewide plan in Maine is being a test bed to insure all working people and their families in the state with some form of coverage. Solving that problem is above my pay grade so to speak.
One major problem with the concept of health insurance is that there is no clear and reasonable metric for the level of care that should be provided. If I purchase collision insurance for my car with a $250 deductable, then in the event my car is involved in a collision my insurance company will pay be either what it costs to get the car into condition comparable to what it was prior to the collision, less $250, or buy the car from me for about what it would have been worth, pre-collision, less $250. The cost to the insurance company of either of these actions is reasonably-accurately quantifiable.
Health insurance, however, is another matter entirely. There are many people who cannot possibly be gotten to a state of 'perfect' health, but could be gotten into a better state if they receive $500,000,000 worth of care than if they receive $500. How much should the insurance company spend?
I believe insurance companies and Major League Baseball are the only two industries exempt from anti-trust laws.