What would have proved, in all probability, to be the most effective cost containment feature, viz. the public option, of Obamacare was defeated by Republican opposition. In the end, one has to conclude that keeping as much of U.S. medical care in control of the private sector as possible -- never mind that U.S. private sector medicine is a government protected cartel -- was more important to Republicans than cost containment. I have to respect that position, even though i think it fails to recognize that when you have a cartel delivering a service that no one can refuse, you have a very serious cost containment problem, and therefore i think the public option was the least bad choice.
Something will, of course, eventually have to give. And then someone is going to make less money! Who will, or should that be? That's the third rail of medical reform that no politician will ever voluntarily touch until they sense that public opinion has moved far enough that even though they touch the rail, they will survive the next election.