“When Obamacare was being debated 2009, proponents banked heavily on its transformative potential. When skeptics caviled about the costs, the reformers pointed out that there were all sorts of pilots, and delivery system reforms like these ACO demonstration projects, that hadn’t gotten scored as cost-saving by the Congressional Budget Office… So far, pretty much every one of those promised improvements has underwhelmed, and the skeptics have been vindicated.”