Nobody knows.

I mentioned to BHO 4 or 5 years ago (before the big "I'll be the last president to introduce universal healthcare" speech in 2010, that healthcare insurance companies subsidize Medicare. Well, either deliberately or just because his mind simply cannot understand the math of it, he said Medicare subsidizes insurance companies. And of course Congress stood up and applauded.
I was that angry--just what is it about spiraling healthcare costs you don't understand?
Healthcare providers (hospitals, doctors, labs)for decades have been contracting with Medicare and Medicaid, to provide healthcare. Government generally was paying about 30-45% of billed costs. Thus providers would have gone broke, had they not raised prices to other private insurance companies and self-pay patients to make up the difference. (Private companies also contract with providers, but at much greater rates.) So over the decades, it became a spiral of costs and payments. Until now we have this monstrous unconstitutional piece of legislations that is breaking the back of the economy.