Prepare yourself during 2013- knowledge required!

Now that the Supreme Court has upheld the Affordable Care Act, should we all just sit back and go for the ride? Hardly.

Progress among the states is a patchwork- only 13 states have moved forward setting up health exchanges- a key enabler. An additional 22 states have started planning. The remaining states continue to resist.

What this means is that when 2014 arrives, the states will not all be ready. Your ability to access decent, affordable care will depend very much on where you live.

And so you should be prepared to look out for yourself, to some degree- with knowledge, so talk to your physician and do your own research; with tools, so use a personal health record, know how to research the quality and cost of hospitals and physicians; and have a network, whether it be through a traditional advocacy group, or through an online social network.

As our system changes and improves, we will collectively be much better off. But during the transition, there will be gaps, and we will all need to become more self reliant.