Lately Medicare has been using its financial clout to force hospitals to improve their quality of care. (Medicare is forbidden by law from negotiating drug prices.)

Medicare shows what an efficient medical finance system can look like. Other wealthy nations have it, or some variant of it, for everybody. That’s a big part of why they pay half what the U.S. spends on health care per person, while insuring everyone and getting medical results roughly equal to those in the United States. The U.S. leaves 9 percent of its people uninsured.

The Affordable Care Act, passed in 2010, punted on cost control, putting only a 15 percent to 20 percent limit on private insurance overhead and no limits on the price of care. Instead, the law known as Obamacare extended insurance coverage to 16 million people. A plan for a government insurance option was rejected.