One cannot create goods and services out of nothing. Yes, there are efficiencies that can be realized over our present system, but this bill isn't about those efficiencies, it's about forcing the medical system to make bricks without supplying it the necessary straw. Either fewer bricks will be made (rationing), or the medical industry will be put to forced labor. Taking money and initiative out of the system will of necessity stifle creativity, bring research to a screaming halt and lower the standard of treatment.