The ultimate goal of the ACA is as Obama/Mao/Stalin/Marx/Castro want it is to level the playing field regardless of talent or drive.
They want US Docs to still provide US hours of private practice (50-60 hours) for many of us in private world. Yet get paid Euro wages. Only problem is they also do not want US docs getting Euro benefits (like 35-40 hour work weeks, pensions, paid 8 weeks off, heavily subsidized schooling, etc).
All one needs to do is look at the big drop in medical school applications after 1996-2000 witth the AAMC data. The peak year was for the the 1996 entering class (1995 applicants).
Something called the Internet boom happened and all the talent and brightest decided to go to the tech business. The number of applications tanked over a 4 year period. Than the apps picked up again after the Internet bust in 2000.
The brightest students aren't dumb. They want to be compensated for their talent.