When the Patient Protection and Affordable Care Act (PPACA, aka ACA) became federal law in March of 2010, there were many assumptions about what the law would and would not do. As everyone knows, it has become known simply as "Obamacare," because President Obama was the one who wanted health care reform. Here are some misconceptions about health care reform.

One of the first statements made was that the new law was tantamount to "a government takeover of healthcare." For this to be true, the government would need to inform every citizen that they were being enrolled in a federal healthcare program, sort of like Medicare, which is a federal health care program for any qualifying citizen or permanent resident over the age of 65. In fact, there is no federal alternative to private health insurance today. Since most if not all health insurance companies that were doing business in 2010 are still insuring millions of policyholders today, it is safe to say that there has not been a government takeover of healthcare. It is also true however, that many people would like to see that happen. They would love to see Medicare expanded to include everyone; but that is very unlikely for many years to come, if ever.

"Medicare benefits will be reduced." Actually the opposite has happened. Medicare now covers annual physical exams and colonoscopies in addition to the quite comprehensive benefits they have long provided. It is true that premium costs to Medicare beneficiaries will go up in future years, but medical costs and premiums have been rising steadily for decades, and seniors do use more medical services than people under 65.

There will be government "death panels" that will make end-of-life decisions for people on Medicare. This idea was borne out of a well-intended provision in the health care bill that would have helped pay for the end-of-life planning discussion cost that the elderly already have with their physicians and caregivers. So a good thing became a bad thing. Now there can be no provisions in Medicare for this benefit which, ironically, hurts seniors and can actually adds to the cost of health care.

Illegal immigrants will now be covered. The ACA specifically prohibits undocumented immigrants from receiving coverage.

What is not known is the true long-term cost of this legislation. There are many people on both sides of the argument, time will tell what the real cost will be, and there are many components of this program still to be implemented. The truth about health care is that it is expensive no matter where you are. Canada, England, France, Switzerland, Italy, China.

All of these countries have some form of government provided health care and while it is less expensive per-capita than in the United States, it is expensive nonetheless. The common element of all health care programs is that every citizen or legal permanent resident is covered. The cost of care per person is far lower when everyone is covered.

What needs to be understood about health care is that every person at some point will seek it out when they need it. Whether or not they have health insurance is not a factor when there is a need for treatment. If a person cannot afford car insurance they have the option of not driving, and few people drive without car insurance. Not so with health insurance, and the situation is made worse by the fact that uninsured people often ignore minor medical issues because of the cost. Unfortunately those minor medical issues have a way of becoming serious, and that is when the uninsured seek care. And where do they go to get treatment then? The emergency room, which happens to be the most expensive entry point into the entire health care system in the U.S. They go there because federal law prohibits hospitals from turning away anyone during a medical emergency.

This is a huge factor in the cost of health insurance, and a major reason why health insurance premiums have risen far in excess of the CPI over the past 30 years. Until that part of the health insurance equation is resolved the cost of insurance will continue to be out of reach for millions of Americans.

In summary, the cost of delivering health care in the U.S. is not going to go away as an issue. The debate over the number of uninsured and whether or not they should be covered, public vs. private insurance, and who pays for all of this will go on until our politicians realize that there is no one best solution. All sides will have to agree that there will always be some elements of a common health care system that not everyone will like. There are many elements of the Affordable Care Act which work, and those elements need to be preserved. Many insurers who initially opposed the Act have since re-tooled their benefit and pricing models to reflect the major objectives of the program. The irony here is that abolishing the ACA would actually increase the cost of coverage as insurers once again had to redesign their policies and coverage. What is needed most of all is a system that works reasonably well and covers everyone or nearly everyone. In the long run, the cost of excluding millions of uninsured will cost more than covering them.