They're going to have to give up paying for things that don't make them healthier. And I--speaking as an American, I think that's the kind of change you want.
This is the fulcrum of argumentation now. The financing questions are both straightforward and obscure, and frankly you really need to know about intended consequences to understand how this is all going to be less expensive and with a reasonable promise to not be in the corrupt hands of insurance executives. The real question is whether or not we are going to have better health care for 99% of Americans. The answer is given in that quotation above. You are not going to get cosmetic surgeries, even if such things would improve your disposition. You are not going to have the option of shopping medical facilities until you get the answers you want, all the while doubling and tripling the covered diagnostic testing of the system.
Health care should be in the hands of competent physicians and other medical personnel. It should not be dictated by the actuarial mathematics of insurance companies, which if you would stop to notice, cancel people's insurance when they have to pay out to that person, that is, actuarial mathematics is the craft of excluding risk. Well, health care is all about risk ... and that is why with the insurance companies in the driver's seat we have a distorted and mostly broken system now.