gavra_at_work,
Regarding your question of “who should decide”, most decisions on health care coverage today are maid by for profit companies whose first responsibility must be to their stockholder-owners. Most actually do try to do the right thing but it is a very difficult system. I knew a medical director of an insurer who decided he couldn’t cover smoking cessation despite the huge medical benefits because they would not save the company money for decades. He just couldn’t demand that the stockholders foot the bill. A government plan, or government regulations, can eliminate this terrible situation.