With a graduate degree in Health Services Management and Supervision, I have avidly read everything I can get my hands on concerning the ACA and its purported effects, both positive and negative. The one thing I see, is that while the Act makes Health Insurance available and more-or-less affordable for segments of the population who could not obtain or afford insurance before, it does not seem to actually do anything about the cost of health care itself. So I thought I would open the topic for discussion and see what ideas are out there. Is tort reform a possible answer, at least in part? In theory, limiting the awards for malpractice claims should lower the cost of malpractice insurance, and in turn reduce a health provider's cost of doing business. Given a lower cost of providing services, then, it seems logical that the cost of those same services should go down. Or will they? How about educational reform? What if we could bring down the cost of a medical education such that student medical providers were not left with huge educational debts? Could that bring down the cost of health care services? If it were cheaper to get a medical degree, would more students choose that path leading to a greater supply of health care workers? Could a greater supply then lead to lower costs due to competition? The health care industry is a business, let there be no mistake about that. So what sort of changes to the business model are needed to bring down the cost of services? What bothers me about the ACA is that none of these questions seem to be answered. In most business models adding layers of bureaucracy generally raises operating costs in a system. In health care, insurance companies, while spreading the risk across a larger population (which shares costs) can reduce some individual's costs, the insurance company has to get their cut (they are a business too), which could cancel out any cost savings. This brings me back to my original question: How do we as a nation or a society bring down the actual cost of health care at the point of service?