and then mark pauly is a professor at the wharton school at the university of pennsylvania. mark is well known to aei audiences and has written many papers for us and looking forward to what he has to say. so with that let's start. >> good morning. this is a great time to sort of take a snapshot at what's going on with the health care law. i think i would agree though with some of the commentators i've read recently, some of whom are very strong supporters of the law that it's going to take much longer than the three months we been into this to really understand full implications of this. probably be a two or three-year process before you can really figure out whether it's change the interest landscape in a way that's positive or negative, at a cost structure of the country and positive or negative ways. we are very early into this to make judgments, but we work at a think tank and we do cover decided to go. we are going to do anyway. i read, apologize for the smalltalk, too much to cover in this. i weeded out to you, but i was very struck by a column written by our colleague

then mark pauly is a professor at the wharton school of the university of pennsylvania. mark is well known to aei audiences and has written many papers for us, and we are looking forward to what he has to say. with that, let's start with jim. >> good morning. this is a great time to take a snapshot at what is going on with the health care law. i think i would agree with some of the commentators i've read recently, some of whom are strong supporters of the law, that it is going to take much longer than the three months we have been into this to really understand full implications of this. it is going to be a two- or three-year process to figure out whether it has changed the insurance landscape in a positive or negative way. we are early into this debate judgments. we work at a think tank and we do conferences, and we will do it anyway. i read -- i apologize for the small type. there is too much to cover in this. i will read it out to you. i was struck by a column that was written by a colleague at aei who wrote and summed up my thinking about this specifically. he said is

and then mark pauly is the a professor at the wharton school at the university of pennsylvania. mark is well known to aei audiences and has written many papers for us, and we're looking forward to what he has to say. with that, let's start with jim. >> well, good morning. this is a great time to sort of take a snapshot at what's going on with the health care law. i think i would agree, though, with some of the commentators identify read recently, some of whom are very strong supporters of the law that it's going to take much longer than the three months we've been into this to really understand full implications of this. it's probably going to be a two or three-year process before you can really figure out whether it's changed the insurance landscape in a way that's positive or negative and the cost structure of the country in a positive or negative way. .. or is it a story of survival? i do think it is much more a story of survival than it is a success story so far. so the thought process is let's look back, think about if you were talking about the prospects of health care law

i think the two big things that have brought this aircraft carrier enterprise to a slow glide, mark pauly over to one of them, which was this industry doesn't have a lot of new products to sell the public. if you look at the hospital of 2013, technologically it's pretty much identical to the hospital of 1998. device innovation, new technologies for ambulatory. there really aren't a lot of new technologies in the hospital sector. and this recent reacceleration of cost i think a lot of people really point to the fact that, i me, only in health care is that somehow bad news. okay, or something to really worry about, we have effectively cured hepatitis c, arguably our third most significant chronic disease risk after diabetes and alzheimer's disease. but, you know, when you look at the deflection points in spending for the fairest sectors in the health system, they go back in some cases as far as 15 years. pharmaceutical spending went downward in 1990. imaging spending, $200 billion business that was growing at 15% a year didn't downward and almost came to a halt starting in 2006. hospital ou