There's a whole bunch of very important stuff built around improving health care efficiency and lowering costs but not standards, with a whole bunch of pilot programs and other things that actually tend to work, which is important.

As for your "who decides" thing - well, the government does. Who else do you want to decide? There comes a point where you have to assume that the government will be doing things fairly, and if you find out they aren't, you fix that, but you still have to let the government do it. Because who else? The government are the only ones who have the authority and who have any real chance at operation on a basis of "for the benefit of everyone" rather than "for the benefit of shareholders".

Not that spectacular a chance, alas, given how comprehensively terrible campaign finance issues are in the US. But a chance.