I agree with Owain, I don't think "opening up insurance markets across state lines" would make difference. The system is not price conscious and is not driven by supply and demand.

Anecdote: A while ago I worked for a place that had "Cadillac insurance". Anything you could imagine, it was covered. Seeing everything was covered, I decided to go to a doctor to complain about poor memory. It was related to getting up at 5am to get to work, but I wanted to see if there was something else. I was prescribed 1 on 1 assessment with a memory specialist and MRI when in my opinion simple blood work would have done the trick. More so, I wanted to turn down MRI but no less than 3 different MRI companies in town called me and offered to send me a limo to my work. Really. A limo. So I ended up having MRI. Not only I had no incentive to be frugal, there is psychological (e.g. but what if?) incentive to over-consume. Out of curiosity, I tried to find out how much this costs. Couldn't - nobody I could talk to really knew. Insurance sorted this out.

Meanwhile some folks going without and/or getting bankrupt.

Now tell me how this is market-rational system when not only consumers don't directly pay, but it is often impossible to find out prices.

When I eventually moved on from that place, I found out that COBRA payments for that plan was about $2500 a month. For 100% healthy adult with no preexisting conditions.

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