re: All things considered, why is the Federal government involved at all in health insurance ?

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How would it be if there was simply state and local oversight of doctors and hospitals and routine doctor visits could be paid out of pocket and insurance was only used for catastrophic situations?

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"Routine" doctor visits can be very costly ( $160 on average). Medications that some people need on an ongoing basis can be very expensive LINK. If you have any issue that the PCP thinks should be looked at by a specialist, that's a lot more money( Average $350 for an OB-GYN, for example). If the specialist thinks a "routine" test, like an MRI for example, is necessary to diagnose the issue, that's a lot more money ( $500-1300 for MRI). A person who is struggling to pay their rent and feed their kids can't come up with the money for "routine" medical treatment.