Let’s be clear, the Affordable Care Act was never about reform of health care it only reformed health insurance. Care is something different, and if we’re going to evaluate the ACA fairly—and honestly debate alternatives—our focus must be on how much care people are getting.

Healthcare systems exist to optimize the health of individuals through timely access to necessary care. While getting value for our spending is important, saving money per se is not the primary goal of healthcare, care is.

The U.S. healthcare system is failing the American people; access to care is neither timely nor sufficient and spending is dollar-inefficient. Money is increasingly spent on non-value-adding activities such as bureaucracy, thus taking resources away from patient care.

This was true before the passage of the Affordable Care Act. Washington has been “fixing” healthcare since the 1965 creations of both Medicare and Medicaid. It was prior Washington fixes that had made our insurance unaffordable and our care unavailable. The Obama administration’s touted solution was the Affordable Care Act. And because of the ACA, the cost of already unaffordable health insurance doubled and access to care declined despite 20 million more Americans having insurance.

Some members of Congress now want to double down on this failure by passing House Resolution 1384, a Medicare-for-All bill. The results would be catastrophic.  Every U.S. resident might gain coverage, but access to care would suffer dramatically.

First, patients will have no personal responsibility for their own care. Section 202 prohibits cost-sharing, “including deductibles, coinsurance, copayments, or similar charges.” Enrollees in Medicare-for-All have no “skin in the game.”

When consumers are entitled to health care, they don’t care how much they spend or what demands they make. They have no incentive to make prudent choices. They spend other people’s money without restraint. The result is over-spending, precisely what we have now—but on a far grander scale.

Without consumers accepting the need to spend money wisely on their health care, the only way to limit expenditures is by medical rationing, an integral part of all single-payer systems, including Medicare-for-All.

And that’s something Americans won’t accept.

Next, we can expect the government to crack down on any competition to its single-payer scheme.

HR 1384 eliminates both individual and employer-supported health insurance for most health care services. Section 107 states, “it shall be unlawful for … a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.” The list of mandated benefits is quite comprehensive, including “all primary care, hospital and outpatient services, prescription drugs, dental, vision, audiology, women’s reproductive health services, maternity and newborn care, long-term services and supports, prescription drugs, mental health and substance abuse treatment, laboratory and diagnostic services, ambulatory services, and more.”

There is little or nothing left out.

Keep in mind that “benefits” actually refers to the government’s promise to provide care, not for the actual delivery of care. The American people have learned painfully, in some cases fatally, that coverage benefits listed on paper does not equal care. Having government insurance such as Medicaid, Medicare, TriCare for veterans, or ACA insurance has already resulted in death-by-queueing.

Finally, Medicare-for-All would expand the health care behemoth, but not in the care department. As Aetna’s Joe Cantlupe reports, “The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.” And that was before the ACA further expanded the federal bureaucracy.

Medicare-for-All calls for ever more layers of bureaucracy. And bureaucrats don’t come cheap; the result will be even fewer healthcare dollars available for care.

The American people need nurses, not navigators (a new bureaucratic job created by the ACA); doctors, not directors; and most particularly, care, not coverage.

But we can choose a different path. Instead of increasing federal authority over healthcare, we need to reduce Washington’s role and put decision-making where it belongs—with the people in their states.

If Californians want a single-payer system and Texans want a market-based one with a safety net, they each should be able to do so.

Our goal must be to help patients. Medicare-for-All won’t accomplish this. Letting the states go their own way will.