The problem is eliminating Medicare is essentially a prerequisite to meaningfully reducing healthcare costs. As long as there is a deep pocket to pay whatever outrageous prices people are charged, people will keep getting charged outrageous prices. Take away the money and the price would come down in a hurry.

Is it really Medicare, or medical insurance in general?

What you would need to solve this is socialized medical care supervised by the government, who takes from those who can contribute and gives to those who are in need. It wouldn't have to be completely run by the government but would have to be supervised by it.

> Is it really Medicare, or medical insurance in general?

Medical insurance that works like Medicare obviously has the same problems. But imagine medical insurance where, instead of paying obscene premiums with a low deductible, you pay very low premiums with a deductible of several thousand dollars after which the insurance pays 80%. So if you get cancer you don't die of poverty but for pretty much anything else you're paying out of pocket, i.e. medical insurance, not a payment plan that hides true costs from everybody.

Now the thing that costs $10,000 in one place and $4,000 in the other place is a difference you care about, so you pay the $4,000 (and so does everybody else), causing total medical costs to fall. You also eliminate all the insurance paperwork in any year you don't blow the deductible, allowing doctors to lower their own costs significantly.

However, this leave people still exposed to diseases where the thing that maybe helps you does not cost $10,000 but $100,000 (not uncommon) or $1,000,000.

For instance, recently I read about carfilzomib or sipuleucel, both cancer medicines; $100,000 doesn't get you there yet.

The only reason they can charge $100,000 is that there is a deep pocket to pay for it. It does not cost that much to manufacture the drug. It might cost that much to do the research, but if you want taxpayer funded research then do taxpayer funded research. There is no reason to launder the research subsidy through seven layers of bureaucracy.

The cost and structure of US healthcare is rather a different problem, although potentially both have to be solved to make it work there. In Europe health insurance in many countries is 100-200/month with a few hundred in deductible.