The Economist joins the chorus of those who say that “America’s health spending will continue to soar under the reforms.” Many have contended that it was a mistake to have expanded coverage without first controlling costs. The real mistake was not in reversing the order of coverage expansion and cost containment, rather it was in the failure to do both simultaneously through the adoption of a national single payer program.

One of the claims made by those supporting the health care legislation that placed the private insurers in the drivers seat is that these private firms would be masters at innovation. Well, we are now seeing some of that innovation as they are making their early moves to take over the health care delivery system. It might not be good for our personal finances nor our health, but it is going to give a spectacular boost to Wall Street.

Although this looks like another cute trick that Dick Armey tried to pull off, it is much more serious than that. This is a another blatant effort to try to destroy Medicare as a social insurance program to which all people over 65 who are receiving Social Security benefits are entitled.

This study from the Dartmouth Institute confirms the intuitive observation that the number of diagnoses of serious chronic conditions in Medicare beneficiaries has a positive correlation with case-fatality rates. The greater number of serious problems a person has, the greater the risk of death. But observation of the regional distribution of these serious diagnoses provides troubling results.

What will happen to employer-sponsored coverage under the Affordable Care Act? Perhaps one of the most alarming provisions of the Act is that plans with a 60 percent actuarial value (patients pay an average of 40 percent of their health care bills) qualify to fulfill the employers’ obligations to provide coverage or pay an assessment. Thus the Act is establishing under-insurance as the new standard.

This Swiss discrete choice experiment, evaluating willingness to pay, indicates that both physicians and patients want greater compensation if they are to shift from the traditional fee-for-service arrangement to a coordinated care program.

You do not have to read this entire 254 page report to have a good idea of some of the options to be considered to reduce our federal budget deficit. Pages viii-xiv of the Table of Contents lists the options for reducing mandatory spending, reducing discretionary spending, and increasing revenues. You can then proceed to read about any of the specific options that you my find intriguing to see what impact they might have on the deficit.

The patient service mission of not-for-profit Carilion Clinic would seem to have little in common with the for-profit insurance business of investor-owned Aetna. With the pressure on to beat the market by forming accountable care organizations called for in the Affordable Care Act, partnerships such as this that blur the distinction between health care delivery systems and private insurers were fully predictable.

We keep looking at Massachusetts since it serves as a prototype for national reform under the Affordable Care Act. Under this latest development in Massachusetts, state employees are being shoved into limited-network plans – significantly limiting their choices of health care professionals and institutions.

“Unaffordable underinsurance” is rapidly becoming the new standard in the United States. Even with subsidies, insurance premiums are ever less affordable, and for those who need health care, out-of-pocket spending creates significant financial hardships. Since reform under the Affordable Care Act closely mirrors that of Massachusetts, their current experience with medical bankruptcy portends the future of medical bankruptcy throughout the United States.