I work for a health insurance carrier. You are the one that does not get it. The high cost of health care today is not because of lack of choice but utilization. People are over using the health care system.
A #15 generic drug would work fine for most people but they see the latest drug comercial on TV and DEMAND their doctor put them on the $300 per month R/X because they are not paying for it.
MY local BC/BS has over 225 plans to pick from BTW
It's both.
If it was up to the individual consumer to make all his own medical decisions and there were lower-cost choices available and if he was spending his own money out of his own pocket, he would not "use" so much.