I don't think it's possible because

the needs of shareholders are different from the needs of patients. And the way that insurance companies are able to assure shareholders of greater return on their investment is by doing things that makes it more difficult for people to get the care that they need. There's this thing called a medical loss ratio in health insurance. And what that means is health insurance considered a loss when they pay a claim. And one thing the Affordable Care Act did, because I testified before Congress about how this works, increasingly, Wall Street was pressuring these companies to spend less and less and less of our premium dollars on paying our claims, to the point that some insurers were using less than half of our premium dollars paying our claims. Congress, with the passage of the ACA, included a provision that requires them to spend at least 80% or 85%, depending on the kind of health plan we're talking about, on health care. But these companies have figured out how to game that, how to work around that in ways that have enabled them to amass even more profits. We now have more than 100 million Americans who have medical debt. And the vast majority of those people have health insurance, but they're not able to get the care that they need and can afford primarily because one of these other barriers that I've referenced, high out-of costs. That was another reason why I left the insurance industry. It's because of the medical debt that these companies have created for people with insurance by making them pay increasingly high deductibles. I was expected, if I had stayed on with Cigna, to be a leading cheerleader for these kinds of health plans. We were marketing them back in the day as consumer-driven health plans. Euphemistically, we called them that because we wanted people to think that somehow Americans were just chomping at the bit to be more involved in their health care or spend more for their health care. And as a consequence, we have to pay hundreds, if not thousands of dollars out of our own pockets every single year.

After the break, we'll hear why the political effort to reform the healthcare industry has often fallen flat. We'll be right back.

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Jonathan Cohn is a senior national correspondent at HuffPost and the author of the book The Ten Year War, Obamacare and the Unfinished Crusade for Universal Coverage. There

has been discussion of the problems of our healthcare system really since the 1930s, which is pretty much when we first got a healthcare system. And some would say we've never really had a healthcare system, more we have healthcare problems and these sort of solutions that get thrown at it that don't work or don't get enacted. So people have never been happy with it. The two caveats, and maybe this is something we can discuss a little later, are that that's a very general statement. There are always certain people for whom it works reasonably well and feel pretty good about it. And that is related to the second part, which is that however unhappy people may be at any one point with the status quo, when you get to the discussion of fixing it, of changing it, of doing something, the enthusiasm for change wanes and the consensus over what to do breaks down. And that's a big reason why, you know, the problems persist.

I guess I'm sort of confused, Jonathan, from the health insurer or the hospital's perspective.