The incentives have been degrading for over 50 years. Most folks do not know that the government was responsible for 50% of the total expenditures in healthcare before ObamaCare. Competition, that glorious process that minimizes cost and maximizes product features and delivery, has not been present in healthcare, and with ObamaCare the competition will be replaced with ultimately wage and price controls, the opposite of competition.
Health insurance companies don't need to compete for your business -- they're all offering the same product, anyway. Moreover, because of government regulation concerning how health insurance is taxed, most people aren't choosing their insurers. Their employers are.
As a result, insurance companies have become outrageously unresponsive to both patients and doctors. Insurance companies need only concern themselves with satisfying government regulators and corporate purchasers. Meanwhile, doctors have to please only the insurance companies, which don't particularly care how patients are treated, as long as it's cheap.
This is a third-party-payer problem, or as the proverb goes, "He who pays the piper calls the tune." All third-party-payer systems are disasters. The customer is trapped, forced to pay for something he doesn't want, with no one to complain to and no possibility of taking his business elsewhere.