How about instead of cost shifting and purchase pooling we actually work on what medical care costs in the first place? In the US you can got to Cook County or the US Federal court in the Eastern District of Texas and drive up a drug company's everyday costs by suing them in a class action for side effects they already disclosed before you bought their drug. There should be some sort of grand jury or board of people with a clue who decide the merit of these things before millions are spent on lawyers.
The for-profit speculative commission-only trial lawyers are a big part of service and product costs for drug companies, hospitals, clinics, doctors, nurses, and even medical assistants and medical techs. If you want to make healthcare more affordable through insurance cost changes, change the cost of malpractice insurance so that only people who actually screw up need to pay exorbitant premiums. When I lived in Illinois it was really difficult to get a doctor's appointment within six months without crossing state lines because the malpractice rates caused several of the doctors in the area to retire early or move to more sensible states.
Also, why do we have federal and state funds going into basic research at universities that gets patented and sold to corporations to turn into products? If research comes from a largely government-funded school then the NIH or someone should be licensed to then sublicense any of those patents to all comers for a reasonable fee.
Also, why do the drug companies pay the FDA to fast-track drugs? The PDUFA means that in order to get faster drug trials, the deeper pockets get faster times to market. If we're spending billions of dollars to improve healthcare, why don't we fund the FDA sufficiently to get the best drugs approved fastest rather than the most heavily promoted ones? Why don't we partner with other developed countries to do joint trials that meet the standards of the FDA and its counterparts in, say, the UK, Germany, France, Japan, South Korea, Canada, Finland, Sweden, and Brazil with all the agencies reviewing all the data and making decisions for their own constituencies rather than repeating the trials over and over?