What I think the bill got wrong is that the process was so partisan and one-sided that it really divided the country in a political way. The Republican side is the intractable opposite that had an unwillingness to accept what's going on. Also, the way in which the implementation was done was a real problem - it wasn't done competently.

DOTmed: Do you think that health care will be sustainable under the current ACA plans?


GW: The biggest problem is Medicare - there is a real cost crisis there because it's not adequately funded. There's only one dedicated tax source for it, which is the part A tax that going to run out within a decade or so. Parts B, C and D have some general revenue funding, which basically means that we're printing government bonds to fund those programs as it is.

We do have a real tax burden in front of us unless something is done. As far as Medicare, there are some reforms that are in the ACA to try to experiment around the edges to bring down health care costs. I think some of those reforms are getting tested in the marketplace and I think that's helpful.

Obviously, the subsidies in the ACA to pay for additional people to have health insurance are another expense. If the goal is to manage the deficit then I don't think the ACA has done really anything to help that problem.

But I think it has taken some meaningful steps in reforming the health care system and there may be some payoff down the road in trying to bend the cost curve. However, I don't think that the basic structure of what's being paid in and going out has really done much for the deficit.

That being the case, the Medicare program is going to have to take some additional steps in the next decade to somehow deal with closing this deficit. There are some major proposals that as a country we haven't really made our mind up about yet.

Some of those were presented in the last election - Romney Ryan talked about premium support, which has not received much of a warm reception. Then there is the alternative side to fix Medicare, which has a lot to do with making the wealthy pay more for their part B programs and delaying the retirement age in which you can access Medicare benefits.

There are a series of those types of incremental steps that will save some billions of dollars and help to close the gap. There is a debate as to which of those or maybe a combination of those that we're going to pursue.

DOTmed: Now that Republicans have control of the House and Senate, what do you think they should change about the ACA, if anything?

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