Want to know what the future of health care looks like? One model is Kaiser Permanente, which combines a nonprofit insurance plan with its own hospitals and clinics, the very kind of system the ACA encourages. Only this was not mandated; it comes from free enterprise, using great electronic recordkeeping and coordinated patient care that pays a fixed amount of medical care per member. The result is a form of accountable care that is driving strong results. But with the cost of health care still high, Kaiser Permanente still sees major challenges, not the least of which are where the organization sees health care itself going, eventually: toward rationing or re-engineering. Read on.