​Gerald Kominski is the director of the UCLA Center for Health Policy Research, which recently partnered with Prevention Magazine on a survey of attitudes toward health insurance in the U.S. In this brief interview, he discusses survey results ― showing 9 in 10 respondents are satisfied with their health plans ― and what can be done to rein in costs outside of the ACA as the incoming administration discusses how to "repeal and replace" the law.

Q: What does the survey reveal in terms of feelings about the Affordable Care Act?

​There's been a lot of misinformation about how people feel about the Affordable Care Act (ACA). The survey we conducted shows that people are satisfied or even very satisfied with their coverage and want to keep their current health plan.

There are concerns about costs ― but the overwhelming message seems to be that Americans do not perceive their health care system in need of a radical change along the lines of what is being proposed by the incoming administration.

Q: Does the survey reveal concerns about cost?

​Yes, and affordability has been an ongoing concern of Obamacare. But affordability will be a concern no matter what plan is in place because health care spending isn't effectively controlled by insurance companies, and the incentives for providers to control spending are weak or nonexistent. Everyone wants health care to be cheaper, but don't want to give up anything to keep spending under control. You know the saying, having your cake and eating it too!

Further, Obamacare would be much MORE affordable if important stronger penalties for remaining uninsured had been enacted, and if more generous subsidies were available even higher up the income ladder. Or, if federal reinsurance of high-cost patients was a permanent program rather than a temporary program that phased out this year just in time for the Presidential election, which once again brings more negative attention to the ACA.

Q: Outside the ACA, what can be done to rein in costs?

​This is this issue that still hasn't been faced by U.S. policymakers or the general public. In fact, we are in massive denial about real solutions.

We can either have broad, unlimited access to every innovation, regardless of cost; low copayments and deductibles; freedom for doctors, hospitals and pharma to bill whatever the market will bear; and accept that this is the price we have to pay for unregulated markets while we also complain about the high cost of insurance and health care. Or, we can recognize that unlimited health care might be too expensive, that providers don't face real price competition in most markets because they have monopoly power, and that insurance needs to have incentives to identify and pay for value rather than volume.

Repealing Obamacare, and creating Medicaid block grants Medicare vouchers are just convenient mechanisms for limiting federal government expenditures; these policies do nothing to rein in costs. But for the immediate future, national policy is going to focus exclusively on cutting federal health spending, not controlling overall health costs.