Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.

Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.

I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – and Medicare and Medicaid costs become critical to any long-term solution of “debt and deficit.”

And over the next year, as healthcare premiums for private insurance start to rise again, the subject will become part of hallway and water-cooler conversations.

So do I think the provisions in the Affordable Care Act (ACA) will succeed in reeling in the rising costs of healthcare? Honest answer: Not really.

There are some provisions that could be helpful. One such notorious proposal is again under attack by Republicans — the Independent Payment Advisory Board. The board will be composed of 12 members representing all parts of our healthcare enterprise including doctors, patients, industry advocates, financial analysts, etc. Its charge is to monitor Medicare costs and advise how to keep them from exceeding the general inflation rate. The board is specifically prohibited from any specific attempts to ration care or restrict benefits.

But opposition politicians have falsely smeared the potential work of this board by saying it will “come between you and your doctor” in deciding what care you can get.

And the Republican majority leader in the House of Representatives, Erik Cantor of Virginia, is now leading the fight to repeal this provision of the Affordable Care Act. The House will fall in line and vote the party line so Cantor is trying to convince some Senate Democrats who are facing re-election in two years to join Senate Republicans in a repeal vote.

But, of course, President Obama will veto any such attempt – so ultimately, this is all about politics not substance. Surprise, surprise!

As you know from my earlier columns, I have reluctantly come to believe that the political process is emotionally unable to make the hard decisions that would cut unnecessary costs from American healthcare. So I do believe that it is precisely some system of outside experts that will “come between patients and doctors” that is required.

We patients have come to believe that the newest technology (drugs, devices, scans, etc.) are what we need and deserve. And the “medical-industrial complex” is constantly coming up with new technology to feed that belief.

And Congress, for obvious reasons, is incapable of making the necessary hard decisions about what is really needed.

So my sad prediction is that if we don’t make these hard decisions, we will be heading for a medical cost “fiscal cliff” within 5 to 10 years – at which point the rest of my prediction is that the federal government would hold an emergency meeting in Washington, much like the banking crisis, and vote to expand Medicare to cover all Americans in order to get the leaking financial pipeline in one place (a single payer system).

Timothy Johnson trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor.  He blogs at Timothy Johnson, MD: On Health.