Reading Lucy-S's story about her honey's problems with medical insurance (this is US centric) reminded me I had recently read a very well done article here by a hand surgeon called "Managed Care and your hands, What you need to know". It talks about managed care and its restrictions causing "a war of attrition from micro - mismanagement and poor flow of care" and how it can make a difference in the outcome of hand surgery even if the patient has the same procedure by the same surgeon. This can easily be generalized to most sorts of surgery.
It is difficult to know what to do about this as an individual. Certainly we should lobby for regulatory control of insurance companies as their excessive profit is the big impetus behind many of the problems. Those of us who can should lobby for the purchase of better insurance through our employer but the option for that level of input is not available to many. Some companies offer choices, maybe a good PPO, adequate managed care and suboptimal managed care with the employee paying through the nose as quality increases. If you can, it is worth it to purchase better insurance.
Some/many don't have the ability to be insured at all.
Think about these things as you cast you votes and even as you make decisions about where you work and where you spend your medical dollars. The time when it was best for someone else to make the decisions for you was always a fantasy. It is difficult and sometimes impossible to wrench that control back but we need to give it our best effort.