>>Are you suggesting that back in the late1960's when Medicare was enacted someone should have said;
>>"Well, Al, it now costs about $250/day to stay in the hospital, just about half your week's pay.
>>But, you see Al, in 2016, it will cost over $7K/day, or 14k weeks pay in current dollars, so in order to cover that, I'll take most of your current pay as a premium."

If you're asking whether insurers should underwrite competently, the answer is YES. Especially when "insuring" against eventual certainties like sickness and death. Insurers are supposed to put aside enough funds to cover predictable future costs and their investment competence is so great that its value rises more quickly than inflation, including medical inflation. For insurers there's nothing new about this situation.

The problem with Medicare was that for decades, whenever a politician pointed out that premiums (tax contribution) to Medicare is inadequate to underwrite properly, taxpayers quoted the usual chestnuts about people being better than governments at investing their own $ and they voted accordingly.

It's undeniable that the resulting Medicare has run as a pay-as-you-go scheme and therefore is a world class Ponzi scheme running out of punters.

The problem with other health insurance prior to age 65 is that competent underwriting is less vital, because responsibility transfers to the taxpayer at the age of 65 which is when the big costs cut in.

This Ponzi arrangement is foist on the young and it will be up to them to undo the foolishness or if they decide to emulate the selfishness, to cut the Ponzi schemers loose to reap what they sowed.

As for costs: your other problem is the perverse incentive for insurers to tolerate increased costs because ACA has capped their margin at 20%. If costs double, premiums can follow suit, % profit follows suit and bonuses and shareholder celebration follows on.

Who should have controlled costs? Elsewhere in the world, citizen physicians cheerfully act as gatekeepers because waste is unethical. But don't worry, the US tendency to attack physicians for not ordering every test under the sun or not performing heroic surgery on 96-year-old Aunt Alzheimer or for performing the surgery without Aunt Alzheimer making a complete recovery afterwards, is catching on elsewhere so you can be sure that the pain will spread.

Once physicians are dis-empowered, the only remaining entity with motive and capability of controlling costs rather than excising patient muscle and bone, is government. The same people who prevented government underwriting Medicare properly will vote against any government measure that might be interpreted as a "death panel" to prevent Aunt Alzheimer getting her liver transplant. Government presently is reduced to trying to drive down physician incomes relying on elderly voter impressions that physicians are wealthy enough and it's OK to tax the rich but not me. But how can this work when physician income is an increasingly small fraction of overall cost. I gave up when an administrator quoted control over physician income as a way to save 10% of cost when physician income made up only 8% of his cost. If people want physicians to be forced to walk away from the Ponzi scheme, this is a reliable recipe.

Who to blame? I'll give you a clue: try as you might, I am only the messenger, I played no part in this colossal Ponzi arrangement!