Here is another little tidbit: Up until now, we haven't really known how the insurance plans offered on the exchanges were going to play out, and how the new ACO model was going to work. Well, it turns out that the exchange plans are trying to contract out at Medicaid reimbursement rates (except Colorado for some reason) ... not Medicare, Medicaid. At a recent meeting for members of my specialty, none of the large practice groups were planning to contract with the exchange plans. None. This means that we are going to be adding millions of people into the ranks of the "insured" and they are going to have an awfully hard time finding providers to take care of them. Basically the already strapped county systems and the ERs are going to get killed (especially when you consider that these high deductible plans are going to cause people to wait until a crisis before they get care).
Even places like Cleveland Clinic and Mayo, who are the "models" of how this system is supposed to work are not going to be able to afford getting sacked with tons of new patients who reimburse at terrible rates.
So what we are looking at is going from a crisis of coverage to a crisis of access to providers, thus leading to Phase 2 for the progressives which is to force providers to take their coverage. And then we will truly have government run healthcare.