Cost Control after the ACA

Th is Perspective explains why implementation analysis of the cost control provisions within the Patient Protection and Aff ordable Care Act is not particularly useful. Th ese provisions are either relatively straightforward or, more commonly, so fl awed that successful implementation is highly unlikely. Th e analysis shows that eff ective and equitable cost control will require coordinating payers to create all-payer fee setting. Th is poses signifi cant challenges but has been implemented relatively successfully in many countries. Th e balance of the article uses experience with all-payer systems in other countries and fee setting within Medicare to identify key choices within any allpayer system. It highlights the importance of simplifying considerations and focusing on outcomes—the incomes of providers and total spending—rather than engaging in a hopeless search for technocratic payment “accuracy.”