“USA, USA, USA,” cheered the crowd anticipating the upcoming fireworks off Arnolds Park on West Okoboji Lake at twilight on this Fourth of July — thousands of people on land and hundreds in boats on the bay, all celebrating the birth of the land of freedom and opportunity. It is with this sense of freedom (specifically the freedom of speech, which the Des Moines Register reported the same day to be one of our most-cherished freedoms), and it is with this sense of opportunity for the future that I start this blog dedicated to the improvement of health care in Iowa.

During the next 18 months, guest bloggers and I will describe, evaluate, discuss, criticize, highlight, dissect, potentially improve, and — hopefully at some point — complement the effects of the Affordable Care Act (ACA) on the residents of this great state. We will dig into topics of health-care costs (our biggest problem), health-care access, Exchanges (now called Marketplaces), Medicaid expansion, Medicare, competition in the private insurance market, health-care labor needs, independent physician associations, preventive health care and early detection, coordination of care (our greatest opportunity), government vs. for-profit vs. not-for-profit health care, rural health care, and, most importantly, the value and ultimate economic wisdom of ensuring that individuals have health care coverage (to me, the essence of living in a land dedicated to freedom and opportunity).

As someone who has, for more than 25 years, been active in health-policy issues here and nationally, I have witnessed and been a part of many efforts to improve health care; I have met Iowans and others outside of Iowa who have shared with me their wisdom and visions of how health care could be made better; and, finally, I have spent untold hours considering — as a family physician, geriatrician, and hospice director who has had more than 100,000 patient-doctor interactions — how these theoretical ideas can affect real patients’ lives.

For better or worse, I share some of this with you in this blog. For the better, I will ask some of these wiser individuals whom I have met to guest blog about their own really fine thoughts and ideas.

This blog will end on December 31, 2014, with a summary of how the Affordable Care Act has fared in Iowa. The next 18 months will be a watershed for health care. Iowa, as always, will be a microcosm for this unfolding of the future of health care. That said, let us get started.