Somewhere along its tortuous path to enactment, health care reform turned into health insurance reform. Although providing coverage to more than 30 million uninsured Americans and eliminating the unsavory practices of the insurance industry are major achievements, the Affordable Care Act does not do much at least in the short term to change the care most Americans receive or to slow the growth in health care costs. In this article, Robert Berenson presents some of the elements in the legislation that offers the potential for cutting costs, and more pointedly also presents some areas ripe for action that the legislation did not touch. In particular, he points to the growing issue of provider market power in negotiating payment rates with health insurers as one that needs immediate attention.
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