Abstract: Critics and supporters alike have framed the Affordable Care Act as an effort primarily aimed at expanding access to health care insurance. As the refrain goes, the legislation placed much less emphasis on pursuing ways to make health care delivery more affordable. This analysis belies significant measures that the legislation pursues, in the name of cost control, which will fundamentally transform the delivery of medical care. These provisions are based on a primary belief that there is a lot of waste in the delivery of medical care. Moreover, the president and his advisers believed that this waste owes largely to the inefficient and sometimes inappropriate decisions made by providers. The legislation sets out, through a collection of policy measures, to restructure the organization and delivery of medical care. Among other things, it consolidates providers around hospitals where they will become salaried employees that are easier to regulate and supposedly less likely to overprescribe services. History shows, such measures do not produce the promised savings. Moreover, this reorganization comes at a significant cost, not only in terms of the quality of medical care, but its affordability. Provider productivity will inevitably decline. Continuity of care will suffer. Entrepreneurship in medical practice will be squelched. Obamacare will dramatically change the practice of medicine. This will perhaps be its most enduring legacy, and its most significant human cost.
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