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This Perspective explains why implementation analysis of the cost control provisions within the Patient Protection and Affordable Care Act is not particularly useful. These provisions are either relatively straightforward or, more commonly, so flawed that successful implementation is highly unlikely. The analysis shows that effective and equitable cost control will require coordinating payers to create all-payer fee setting. This poses significant challenges but has been implemented relatively successfully in many countries. The balance of the article uses experience with all-payer systems in other countries and fee setting within Medicare to identify key choices within any all-payer system. It highlights the importance of simplifying considerations and focusing on outcomes—the incomes of providers and total spending—rather than engaging in a hopeless search for technocratic payment “accuracy.”