[pessimizer]

It's a very good question. It's why M4A was always a pragmatic centrist compromise, when really to get maximum efficiency you need an NHS. It's weird that Romneycare ended up playing the part of the radical communist bugabear for the right as premiums skyrocket and more profits are being made than ever. VA hospitals for all would be the real lefty dream.

[fakedang]

Come to the NHS in the UK to see maximum operational efficiency. Pretty efficient if you died waiting for your turn in line, or because the government decided that your ailment isn't severe enough to warrant the use of that blockbuster therapy.