Open letter to the President

Dear Mr Obama,

I've been following your efforts to introduce healthcare legislation into the United States with interest. It is of course high time for an aspiring first world country to have this but I realise that several of your predecessors have tried and failed. I wish you better luck.
Being fortunate enough to live in a country where the ABC of resuscitation is not 'American Express, Barclaycard, Chargecard' you may suppose that I am about to be smug. Not at all. Indeed it is precisely because I am a cog for the third largest employer in the world that I know the system's strengths and flaws. I can appreciate how incredible is this National Health Service of ours but also I can see its shortcomings and write to urge you, if successful in your initial efforts, not to make these mistakes on your side of the pond.
Currently healthcare in your country is a huge business like any other private sector venture. The sea-change that you have to make is that a state sector service no longer follows the same business principles and that the more it tries to do so the more ineffectual it becomes. Let your traditional managers run the show and you will probably be worse off than now for not only will the system fail but it will not provide the niches of excellence that you currently do have.
Here is an area where all the key personnel by definition have started on the shop floor and worked their way up. Consultants (attending physicians to you) and senior nursing staff were not born, but made. These people know more about the nuts and bolts of what is required than any health service manager fresh from grad school.
Whilst you will of course need some checks and balances to ensure equity and fair play, please try and keep the system structure simple. The more convoluted layers of management and regulation you put in place the more clogged the whole becomes.
And don't, whatever you do, try and recreate a mini-economy within your health service: the internal market is a distraction and a failure here with no easy way out.
For both good and bad: look over here and watch, and learn.
Best of luck!
Yours sincerely.