I’ll go out on a limb: The next president will have more impact on shaping health care in America than Obama did for the last eight years.

While passage of the Affordable Care Act was historic, the ACA’s current death spiral is inevitable — the consequences of sicker and costlier patients from an insurance standpoint having mandated insurance coverage at lower than market premiums, while healthier and more profitable patients from an insurance standpoint have avoided insurance altogether due to the higher-than-market premiums.

Virtually every intervention our government has employed with regard to health care has made it more expensive, less efficient, less private — and interfered with quality.

With the cessation of the “risk corridor” (read: taxpayer bailout for insurers), insurance companies continue to pull out of the state exchanges versus lose more money, all while further escalating premiums and prices. Where are the savings, better care, and competition the president promised? Five states (Alabama, Alaska, Oklahoma, South Carolina, and Wyoming) will have only one insurance company offering plans on the Obamacare exchange. In Arizona’s Maricopa County, there will be only one insurance company on the Obamacare exchange — and that’s with a 75-percent premium increase.

The average deductible is currently $3,000 and scheduled for a significant increase in 2017. This means a family paying a premium of $1,500 a month with a $3,000 deductible has to lay out $21,000 each year before their insurance pays anything toward their medical bills.

When it comes to health care, the choice for president is as stark as it has ever been: Go further down the road to complete government and insurance company control over health care — or begin turning to a more patient and doctor-directed, personalized, and free-choice system.

Related: Obamacare’s $11 Billion Vanishing Act

Hillary Clinton has said she wants to not only continue with Obamacare but move toward a single-payer system, which would mean higher costs, less choice and waiting lines. Donald Trump has said he will repeal Obamacare and offer a free market solution, which will foster true competition and get government out of the exam room.

This presidential election is about who will enact an agenda that will propel the U.S. toward a path of greater health, prosperity and safety. In regard to health care specifically, this election boils down to a choice between more government intrusion or less; free market medicine versus government controlled markets; individual liberty and choice versus Washington, D.C.-decision making for health care; patient privacy versus government intrusion into privacy; and freedom to choose a plan, a doctor and medical treatment versus an anti-choice government insurance company approach championed by Hillary Clinton.

Related: Even a ‘Rainy Day Fund’ Can’t Save Minnesotans from Obamacare

Ronald Reagan said, “Government is not the solution to our problem. Government is the problem.”

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This is so right when it comes to health care. Virtually every intervention our government has employed with regard to health care has made it more expensive, less efficient, less private — and interfered with quality while leading to more fraud, abuse and waste.

For health care, the decision on who to vote for comes down to this — less government and more free choice versus more government and far less choice.

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Gerard Gianoli, M.D., is a neuro-otologist at the Ear and Balance Institute in Covington, Louisiana, and is a clinical associate professor at Tulane University School of Medicine.