from the marketplace.  Therefore, the patients will go to operators that are efficient and well-run and able to turn a profit.  Well-run organizations adapt to the changing exigencies of the market.  Poorly run organizations don't and lobby hard against any change at all but since life is dynamic, they suffer the same fate as the inadaptable dinosaurs.

You see the same thing in the arguments against raising the minimum wage.  Poorly run businesses cry that they will not be able to operate any longer.  Well run business will survive and thrive as their profitability is not determined by paying starvation wages to employees.

It rewards the larger, more inefficient hospital based providers by allowing them to charge two to three times as much for the same services. It limits physician ownership of ancillaries but encourages hospital monopolization of ancillaries, thus preventing the more efficient small practices from being able to invest in new technology and expand.

Study after study has shown that the small fee for service driven practices have provided higher quality healthcare at lower costs than the large corporate hospital models. That was the entire reason most healthcare was driven to the outpatient setting in the first place. It is now being driven back into the more expensive inpatient setting based, not on economic reasons, but ideological and political ones.

Here is a real world example. If I check an INR (Coumadin level) in my office as a Board certified Hematologist (clotting specialist) I get $23.50 and even then, only if I change the dose. if that same patient goes to the hospital owned "Coumadin clinic" they get $125.00 whether a dose change is made or not..and no physician ever even sees the patient or reviews the Coumadin level. It is all done by a pharmacist only..and usually not even a full fledged one but a pharmacy resident in training. The ACA is full of those sorts of "gimmees" to the hospital owned corporations.

The ACA picks "winners" and "losers" based not on efficiency or running their business well or poorly, but on who their PAC donated to in the last election.