You're muddling the line between democracy and dictatorship.
In a democracy if you control all the votes of people you should be able to make changes in the government that the incumbent may not want. You can't do this in Iran.
I wonder why people focus so much on insurance companies, given their relatively small profit margins. The more glaring issue seems to be provider costs, which are several times higher than comparable services in other countries, with little variance. Are we suffering from a shortage of medical schools? Or from a lack of competition among medical device manufacturers?