The Secret KARL, is that this law is not the end...this is merely a stepping stone. We needed to pass this to prove we could...it does solve some problems, like getting insurance to those that don't have it, but it's not all. You mention premiums and lowering of care, but the solution is obvious if you simply turn to the north. Canada has a far superior system to our own and yet if you check services in things like Cancer survival and Heart transplant etc etc you find that their survial rates are quite close to our own, (I'd say statistically equal but some people want to argue over a 4-10% differential). The difference for canada however is their costs are SUBSTANTIALLY lower. Now yes, we hear about the dreaded "wait times" but the truth is that people in need of EMERGENCY treatments do not have any such wait times. Those with conditions that CAN afford to wait do so and their reward for waiting is they don't go bankrupt getting treatment, example, a knee replacement that costs over 25,000 in the USA costs less than 10,000 in canada...I'll wait the nine months and take some extra aspirin not to pay 2.5 times more for the same thing. There is no doubt the plan is to build on this foundation and direct ourselves towards a full public option/single payer system. It will be hard because some on the right will continue to scream "socoalized medicine" and "death panels" but those people will need to simply be ignored while we make this better for all.