"It's a great deal for states," he said. "Almost every state makes money." The pressure to force Perry's hand, he said, will come from hospitals themselves, which want easier and steadier payment to cover the costs of treating the uninsured. And states will be required to transfer less money than they have had to in order to pay those hospitals' costs, leaving them more money to insure their own employees.

Clear rankings of doctors, hospitals, and HMOs, using information the ACA requires them to disclose, will result in easier ways to decide where to get your care -- and, he insisted in reply to my question about the confusion of weighing plans now and maybe more confusion with new state "exchanges," people will be able to navigate the new choices more easily than they ever have.

"You really can make good decisions in 15 minutes," he said. "I've done it hundreds of times, when I've made students go on to the Massachusetts site that helps you pick between policies. And entrepreneurs will come in and give you a lot of software and programs that ride on top of the exchanges and let you put in what's important to you, to make a good choice."

This will not only give software developers a way to make money -- it will also start to make public the kinds of opinions many doctors already have, from word of mouth, but the public doesn't know. Like, for instance, "whether the Mayo Clinic is really great, and where it's not that hotsy-totsy."

These rankings might rankle the sacred cows of the health industry -- he seems to like singling out the Mayo Clinic -- but can also be an incentive for doctors to use the mentality that got many of them into and through medical school. There is fierce competitiveness and the need to be told they're the best. "Doctors want to excel with patients and also make a good living," he said with unusual understatement. What he really meant was that they want to be the best. I called it the "ego carrot": something that doctors, however uncomfortable with raising the topic of end-of-life care, can use as their own ACA stimulus.

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