> It is interesting that the real cost of medical care and hospital services didn't see any sort of inflection change with the introduction of the ACA.

No one expected it would.

> One the key reasons for implementing the ACA -- which I supported, mind you -- was to control rising healthcare costs.

The immediate reason was to address broad consumer affordability, especially for the people that could least afford it and needed it most.

Long-term, overall cost containment was a long-term goal, but it wasn't expected to have that effect in the short-term, and the pieces that contribute to that either weren't implemented at all, weren't implemented fully, or weren't maintained. (And, heck, a lot of the other pieces weren't in place long before they too started being chipped away at.)

For example, the pieces building on the HIPAA Administrative Simplification provisions designed to by increasing the coverage of transaction standards and doing regular modernization so that incompatible ad hoc approaches wouldn't be needed as extensively were largely unimplemented, with the most important mandated standard operating rules never adopted and the mandated regular (3-year, IIRC) update cycle for the standards and standard operating rules never begun. There are mandated dates in law, but HHS never adopted the required regulations. (That's actually one of the more minor unimplemented cost containment measures, but the one I'm most intimately familiar with because I spent a lot of time those rules were in limbo being involved in planning compliance catch-up and forward looking planning for a component of a state Medicaid system.)

You need 2 things to bring down health care costs (without resorting to rationing): first, introduce price transparency so that consumers can find the low cost providers, and second, provide an incentive for consumers to balance cost vs quality of care and seek out the lowest cost provider for the care needed. This doesn't work for all procedures needed but for huge segments of health care like imaging, this seems to be the best bet.

The key reason for ACA was to get more people insured. In fact the biggest criticism against it was that it would cost too much. No one expected overall healthcare spending to decrease.