A problem with the Obama administration is that it seems to be increasingly based on the Benevolent Dictator model. History tells us that policies based on the assumption that people will act benevolently or against their own self interest will always fail. People will always act in their own self interest in the long run. It might be enlightened long-term self interest, but it will still be self interest.
The genius of our form of government is that it's based on the reality that people can be counted on to act in their self interests, and it is set up structurally to harness conflicts of self-interest in a way that results in a functioning government. This is also the reason that communism failed. The idea of "work according to ability; receive according to need" is based on the false premise that people want to act benevolently toward each other, and they don't.
People who criticize "evil corporations" and assume that government is better than corporations are committing the error of believing the people in corporations are evil and the people in government are good. This is a mistake. Corporations and governments are all human institutions and all are subject to human weaknesses. The difference is that they have different inherent drives and therefore different inherent human failure modes.
A corporation's drive is to maximize profit. The profit motive is good in many significant ways. It forces prioritization in decision making and supports efficient use of resources. But the profit motive isn't 100% good. Left unchecked, there will be cases where the drive to maximize profits results in greed -- behavior that we as a society find unacceptable, e.g., denying insurance coverage to someone who has a policy that was originally sold under the supposition that it would cover the condition.
Government, on the other hand, does not have a profit motive. It's inherent drive is to maximize power. Therefore government agencies will seek to increase their staffing and scope of regulation. Their incentive is the opposite of efficiency. Efficiency means smaller staff and less power, which is the opposite of government's natural drive, so there's an inherent tendency toward inefficiency. Government agencies' failure mode is therefore not greed but bloat. We should not be surprised when government agencies are bloated. We should be surprised when they run efficiently.
The drive to power/bloat doesn't just apply to government agencies; it applies to elected officials. The holy grail of any elected official is to stay in government long enough to get a committee appointment that allows them to direct funds back to projects in their electoral district so that they can be reelected.
Aside from the general pork issue, this also creates a disincentive to shut down programs that aren't working. The people who are employed by a program don't want it to be shut down, so they'll actively work to keep it going even if it's a dumb idea or has outlived its usefulness. Essentially what this means is that there's an inherent conflict of interest between deciding what the best form of government assistance is and simultaneously being responsible for providing that assistance.
How do you solve this problem? I think Reagan had it right when he said you have to starve the beast (i.e., deny it funding, whether it's an agency or a politician). But Reagan era politicians didn't follow up the general notion of starving the beast with any ideological basis for deciding what to fund and what not to fund.
In my mind, the key criteria should be that Federal Regulations should be heavily biased toward approaches that do not result in additional funds passing through any part of national government. In other words, initiatives that increase the money flowing through the national government should be rejected if there is any remotely comparable solution that doesn't increase the money flowing through the government.
Applying this criteria to healthcare, this would mean that laws like "no exclusion for pre-existing conditions" are fine (from this perspective, anyway), because they don't create any new agencies or any more funding flowing through the national government. Moreover, government has no conflict of interest in enforcing this law. It doesn't lose anything by enforcing it, but if the law turns out to be a bad idea it doesn't lose anything by repealing it either.
On the other hand, any part of government healthcare that increases the flow of money through the centralized government's hands should be rejected because it creates a conflict of interest for the government. Single payer is the poster child for this problem. If we ever did adopt single payer, and after a few years experience made it clear that it was a bad idea, the government would have a conflict of interest in shutting it down because it would mean reducing government power. That's an unnatural act for a government just like reducing profit is an unnatural act for a corporation. So we need to have a heavy bias toward solutions that do not increase the flow of money through the government's sticky, inefficient fingers.
National government policing corporations is consistent with the Founding Father's idea of balance of power. Government can guard against Corporations' excessive greed without becoming excessively greedy itself. When government seeks to replace corporations (as it does with single payer health insurance), we are wise to keep one hand on our wallets and the other on speed dial to our congressman.
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