Perhaps it will dilute care, perhaps not. I suspect that those who can afford it will still be able to chose their care. As it stands now, insurance companies already limit care in terms of what doctors can be seen and how long treatment can continue for example. At my age, I have many friends who have been denied coverage because of a preexisting condition. They have no choice but to gamble that nothing will happen to them until Medicare kicks in. Personally, my husband is old enough for Medicare but I am not, so we pay over 1 k per month for insurance which we were able to get sort of as an extension of cobra because he was an officer in the company he retired from. As expensive as it is, I am grateful to have it because I know I would not be able to get other insurance. I worry that my granddaughter may not get a job that provides insurance. I understand your cynicism re government bureaucracies, however, private industry has not provided solutions that might have curtailed the need for the government stepping in. They chose not to do so.