There are a lot of things that need to change to upset it and I think any of them would be valuable.

You're missing the point. Insurance adds fat that—even setting aside the economies of scale and negotiating power inherent in a government-funded system—overshadows the amount of money you'd save by forcing poor people to go without care, to say nothing of the knock-on effects of doing so (preventive care costs less than emergency care). All your talk of torts and malpractice overlooks the inherent problem of for-profit insurance being a pointless middleman that only makes money by denying people care. There are third world countries with better healthcare access than America because of this nonsense. I'd know; I live in one of them. Americans can sustain this system because they're filthy rich, but it's inherently wasteful and in a poorer country people would already be rioting.

Reduce the public financial aid availability - schools will lower their tuition costs and fees eventually, or they'll find themselves with far less students.

Then even fewer students will be able to go to university. It's basic supply and demand.