Soon in this country there will be two types of medical providers: those who demand fee-forservice, and those who will see as many patients as possible to make as much money as possible. In one case those with affluence will still see medical providers quickly, while everyone else will have to wait in line. I have stated multiple times that the Affordable Care Act (ACA) will in fact make healthcare more unaffordable and more inaccessible for millions of Americans. I am not just talking about getting it; I also include the quality. ACA essentially promises undeliverable benefits to everyone.  For too many people, Santa Claus is coming early for Christmas to bring us unlimited free health care that "someone else" will pay for. For medical providers, all services will be paid for by the government, and paperwork responsibilities will lighten. Health insurance companies have been promised an increased base of business because everyone will be in the pool. And of course, the government will run things more efficiently than the free market and save trillions. Todays article focuses on the problem with incentives in ACA. The practice of medicine will change forever, and not in a good way. For over 60 years my family (I am a third-generation doctor) has offered free medical services to a clinic with the Wilmington Hospital to provide free care for those who cannot afford medical services. My family did this because we wanted to- we did not get paid and we received no other reward for doing so. Many medical providers also volunteer their services because we are good people- not members of the "greedy rich" as some politicians would have you believe. I also deal with my own patients on a case by case basis. For example, one of my patients, a poor peach farmer from Kent County, could not afford to pay the bill in full. So he paid the only way he could-with a basket of big, fresh, delicious peaches from his orchard when he came in for his yearly exam. But now because of ACA, that is no longer necessary. The law allows for medical providers to be paid for charity work. Now there will be no incentive to provide charity- all services will be billed to the government. A lot of doctors like the idea of getting paid by the government for people who in the past we treated for free because we were good people. This will add to the budget deficit. Due to the increased workload, in many cases you may not even see a doctor; you might see a nurses aide or a physicians assistant instead. Business-wise doctors may make it, but a large number of old-fashioned doctors like me will step aside because I cant see that many patients that quickly and feel like Im being a doctor. But then again, maybe Im too stubborn. Finally, ACA law gives too much power to bureaucrats, the majority of whom have no medical background, to make decisions on healthcare for patients. This will destroy the doctor-patient relationship which has existed since long before Hippocrates became famous for his Hippocratic Oath. One-quarter of general practioners in America are over the age of 60. Many who do not like the direction medicine is going in will either retire or refuse to take any insurance, including Medicare, Medicaid, or private insurance. You will have to pay a flat fee for their services. The wealthy will be able to afford a good doctor, but everyone else will have to wait in line, and even then you might not see a real doctor. We as humans are hardwired to care for our kin. But as the bureaucracy grows, aided by Obamacare, the patient-doctor relationship will give way to bureaucrats making decisions solely based on cost. Charity healthcare will disappear. My calling will become a trade. Chris Casscells, M.D. Director, Center for Healthcare Policy Caesar Rodney Institute