From what I’ve read/seen the system seems to be almost entirely a creation of unintended consequences of Congress, businesses, and well-meaning insurance companies. Sure there are bad actors but I don’t think they created the system, They only take it vantage of what was created (again, possibly unintentionally) by others.
They invest a large amount in very smart people predicting the consequences and then in lobbying (and bribing) politicians, and in supporting public information campaigns, to pass the laws that provide their desired consequences. For them to portray themselves as innocent and naive, if they do, would be cynical and absurd. It always seems to work out they make a lot of money, but probably unintentionally.
There doesn’t seem to have been a large investigation into the consequences of allowing healthcare coverage to be given to employees without counting as salary. That was one of the core sins.
Why do you think that? Is there something I could read? Certainly lobbying and financial incentives to politicians have existed forever.