The largest implication of the Affordable Care Act (ACA) is broad distribution of the excellent US healthcare system. Cost-benefit ratios should always be considered when selecting between equivalent or near-equivalent treatments. The wider the disparity between cost and benefit, the more legitimate and crucial the cost-benefit analysis. While no treatment should be excluded solely on a cost basis, balance between the need to treat many patients and the financial limitations must be considered.
The impact on daily practice is completely unknown. For independent physician practices, the realities of overhead expenses, time available for patient care, and regulatory requirements can only be assessed when the specific requirements for reporting and reimbursement are clear. Many or maybe most of the practical aspects will depend on the currently uninsured population’s willingness to purchase healthcare insurance or to apply for—and be granted—public assistance. I do have significant concern as to who will be the gatekeeper or tax collector. I am quite uncertain as to whether the ACA can be operationalized, although I prefer testing it in its current iteration rather than starting all over again.