The largest single force that is driving health care in the United States is the Insurance Lobby. Go to any city and look for the largest buildings. It creates overhead that drives the cost up and does nothing to help people other than investors. They rule the industry.
Some efforts and trends influencing this type of decision are millions of Americans with no insurance cover, increase in price of health plans and senior citizens, who are on fixed incomes. To find out more about this, you can visit your local healthcare provider.