There is no layer being added, there is a new rule - get people well or don’t get paid. The guy that taught Toyota how to build quality into their cars, W. Edward Demming, wrote about the failure of hospitals to stop infections and to stop the revolving door of patients sent how too soon or without the possibility of help when discharged....30 years ago. Now a hospital can’t get paid if they keep getting the same person back every week for the same illness. Surprise surprise that cost has gone down in the past 18 months. Why because they are helping the patient. Oh yea the hospitals still seem to be making profits. As a guy to the right of Rush and a former medic I think I can’t be called an ACA supporter.