It's inevitable given the clash of interest. The ideal model for business is to take the customers' money and give nothing back. This is particularly easy with insurance, where the payments are mandatory and the payouts are discretionary. The customers' solution is informed shopping around, but payroll insurance makes that impossible and introduces another conflict of interest: the employee wants the most generous insurance, the employer wants the cheapest.
With all these levels of systems aimed at making or saving money rather than providing healthcare, it's a wonder your costs are only twice or three times what the rest of the civilised world pays.