Health care policy expert Ezekiel Emanuel, brother of former White House Chief of Staff Rahm Emanuel, makes the bold prediction in the New York Times that in just eight years the health insurance industry will be extinct in America. He claims it will be replaced by accountable care organizations, or ACOs. Emanuel’s description of how these future new ACOs will work sounds incredibly similar to how Health Maintenance Organizations (HMOs) are supposed to work.
You may then ask yourself why his prediction about the growth of ACOs won’t just turn out like very similar failed predictions decades ago about HMOs. Emanuel’s justification leaves much to be desired (emphasis mine).
A.C.O.’s are not simply a return to the health maintenance organizations of the 1990s. Although in both models patients are members of a provider network with a specific group of doctors and hospitals, and both are paid primarily per member rather than per procedure or test, there are big differences between them. H.M.O.’s were often large national corporations far removed from their members. In contrast, A.C.O.’s will consist of local health care providers working as a team to take care of patients who are likely to be members for years at a time. H.M.O.’s often cut costs not by keeping people healthy but by denying patients services and by forcing doctors and hospitals to take lower payments. In the 1990s, we lacked the information technology and proven models of integrated care delivery that we have now. These advances will allow A.C.O.’s to simultaneously improve health outcomes and reduce costs.
Lets break his argument into two main parts:
1) ACOs will be local and smaller.
Addressing the issue of size. There were always many relatively small HMOs and there was nothing stopping the formation of small HMOs, if there was a real market or business case for them. There is also little reason to believe that very profitable ACOs will just choose to stop growing or be willing to stop growing to please Mr. Emanuel. After all Kaiser Permanente at one point was a small local ACO-like company until it grew into a huge national company.
2) Technological magic will make the laws of economics no longer apply.
The second point is frankly just wishful thinking. It is possible developments in technology will improve medical efficiency, making it easier to improve health outcomes and reduce cost, but this has been happening for decades. Many efficiencies have already been worked into the system.
The reality is that many other major medical treatments will be expensive for the foreseeable future, so denying care will be remain a smart financial move for the ACO. Providing someone with a more cost effective heart surgery that only costs $60,000 instead of $100,000 is a better financial move, but it still isn’t nearly as good a financial move as denying that person any surgery or otherwise skimping on the quality of care if the ACO/HMO/insurance can get away with it.
There is no reason to believe an ACO, like an HMO, will not try to make money from new efficiencies and also try to make money by denying care and demanding lower payments. If you are paid a set amount ahead of time, the same basic financial incentive to try to do anything to not spend money on the patient remains.
Sadly this basically magical thinking played a huge role in the creation of the Affordable Care Act. Instead of copying proven solutions that have been in use for decades in other countries, we are going to rely on wishful beliefs that essentially claim we will make a new version of a previously failed idea work.




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On a related Obamacare note, when Obama came into office in 2009 staff at the FDA were filled with hopenchange about stopping dangerous medical devices from being approved. Obama’s response was to spy on the whistleblowers!:
http://www.reuters.com/article/2012/01/30/us-doctors-surveillance-idUSTRE80T1SM20120130
Ezekiel Emanuel needs to say that healthcare will cost in America what Canada or France pays he can rave about accountable care organizations but if they can’t match the cost of National Healthcare and drug price controls then America will keep slipping in life expectancy and infant mortality rates especially with this economy.
Ezekiel Emanuel is cheering a losing team.
What ever happened to the computerized medical records Obama was talking about if we had those then oxy pill mills in Florida would go out of business just think of the savings not having so many drug addicts would bring plus lower crime stats druggies commit crimes to buy drugs like stealing and of course driving while high.
2) Technological magic will make the laws of economics no longer apply.
New Tech especially the first to get new tech costs money just look at the latest I phones a year from now the price will drop. America buys the latest tech first so we get stuck with the higher prices and everyone ends up paying more for healthcare for tech that may save a few more lives.
At the cost of more people not being able to afford medical treatment in the first place but yes if you have money America is the best place for healthcare.
We need to address cost being a barrier to healthcare for the 99%. We do not need hospitals buying new tech and passing on the costs to everyone else if only the 1% will benefit from the new tech.
Look at rural and poor access to healthcare it seems obvious they are not benefiting from the new tech heck if you want to see a specialist or get medical tests done with the new tech in some areas of America you have to drive tons of miles.
We need to get more Doctors more specialists and more tech out to serve the 99%.
In a few hours it will be Feb, and another month gone by. Which means just another notch closer to what SCOTUS has to say about ACA in the midst of the campaign pol games.
Regardless of the technological magic and nascent good ideas, we’re at a political crossroads soon. Might that become the intractable power wrench in all of this?
1) ACOs will be local and smaller.
Just how will this lower costs?
big differences between them. H.M.O.’s were often large national corporations far removed from their members. In contrast, A.C.O.’s will consist of local health care providers working as a team to take care of patients who are likely to be members for years at a time.
Given how the economy is this does not address how people will pay for healthcare regulating the insurance industries would do that but O won’t do that.
H.M.O.’s often cut costs not by keeping people healthy but by denying patients services and by forcing doctors and hospitals to take lower payments.
Just what will change that business model?
In the 1990s, we lacked the information technology and proven models of integrated care delivery that we have now. These advances will allow A.C.O.’s to simultaneously improve health outcomes and reduce costs.
Uh we lead the world in high tech medicine in the 90′s and medical costs went up more high tech will only drive the costs further up.
integrated care delivery depends on computerized medical records so your cancer Doctor can know what your regular Doctor and your other Doctors are giving you and vice a versa as long as Oxy pill mills in Florida make money from junkies going from pill mill to pill mill to score we won’t ever get computerized medical records.
Maybe I should look at emigrating to Cuba?
the greatness of ACO sounds like classic underpants gnome theory to me.
Step 1) Create ACO
Step 2) magic/technology magic ???
Sept 3) American health car fixed
Off topic high of 61 degrees in Chicago last day of january I guess the lakes won’t freeze up this year as a kid by Christmas break I played hockey everyday.
I’m betting we go above 110 degrees this summer heat deaths and mosquito borne illness should increase.
t appears that the Hispanic Paradox cannot be explained by either the “salmon bias hypothesis” or the “healthy migrant effect,”[7] two theories that posit low mortality among immigrants due to, respectively, a possible tendency for sick immigrants to return to their home country before death and a possible tendency for new immigrants to be unusually healthy compared to the rest of their home-country population. Historical differences in smoking habits by ethnicity and place of birth may explain much of the paradox, at least at adult ages.[8
http://en.wikipedia.org/wiki/Hispanic_paradox
We are the only first world country that the immigrants live longer than the people with healthcare thats how sad healthcare is in America if Illegals who live longer than second and third generation Hispanics who still live longer than Whites or African Americans despite being on average poorer and less likely to have healthcare were taken away from America’s life expectancy and infant mortality totals we would have lower life expectancy and infant mortality totals than Cuba!
Fixing this should be America’s priority if you don’t care about your own life and your kid’s life then you think Ezekiel Emanuel’s ideas are great.
If your suicidal but not diagnosed and lazy you think the GOP’s ideas of do nothing are even better, if your in a hurry to die then Vote Ron Paul!
No government regulation of business will cause the number of workplace accidents to soar and lower wages government should not regulate a minimum wage will mean you could not afford healthcare anyway.
We heard this one already with free market competing to lower costs would make HMO’s lower healthcare costs:) You would think they could do a better lie than slap a new name on an old idea that did not work.
Step 2) magic/technology magic ??? the magic of Free Markets (suggested edit):)
Zeke must have been losing professional cred in his field. Why else would a brilliant thinker in the field of healthcare throw out a big chunk of brilliant thinking about healthcare. Who cares if it makes little sense and probably won’t work. It is Brilliant Thinking!, which is what Zeke does best.
Does Obama still want to run for reelection claiming healthcare was his biggest accomplishment forcing people to buy health insurance in a depression might actually be the most unpopular thing O has ever done. I am open to suggestions on this and think we should have a contest:)
Not creating jobs, not helping homeowners might be that but O’s plan has yet to take effect. I have not heard any one on the O team until now bring up healthcare in a while.
If Ezekiel Emanuel’s statements are a test balloon then the words Lead Zeppelin fits Obama is only a little behind MItt right now in the polls but if O pushes his record on freakin healthcare as of all things an accomplishment that could cost him maybe 10 points in the polls ( this is a complete guess by the way.
To be fair this sounds like Zeke has been copying Newt’s healthcare plans and his talk about HMO’s in the 80′s. The Dem elite is so brain dead they are passing off Newt’s ideas which did not work in the real world as their own with a new name being the only Real Change.
The Left it seems is the only source for creative ideas that do work and we say copy France because it does work in the real world.
We want results we want better healthcare. We are sick of lying pols who lie to protect healthcare profits over the 99%’s health.
Wow, I think this Times article reads like an ACO prospective investors’ pamphlet.
Here are MY predictions:
* The health insurance industry will thrive with the new ACA legislation, enabling the industry to afford even more lobbyists to ensure that no single payer remedy will ever be available and that their bottom line will be well-protected.
* The health insurance industry will continue to raise rates on their captive audience, and will blame it on rising health care costs. They will be as free to reclassify administrative expenses on medical expenses — thus rendering MLR a useless figure — as they were in 2010.
* State based single payer initiatives will be met with a very hostile response by the industry; ‘death panels’ style PR assaults, and highly aggressive lawsuits initiated by the industry that will claim an ERISA violation. Even if an ERISA violation was never made as a result of a single payer initiative, the lawyers will continue to ruthlessly push states in court in a time and resource consuming legal war of attrition; until a handful of weary citizens complain about their state’s resources being spent in court, and the MSM will give said citizens the “teabagger treatment” (i.e. grant extensive coverage, and treat a few dozen teabagger protesters in DC like Dr. King’s March on Washington). The states will then drop their own single payer health care initiatives.
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I think the only way this wont happen is with a very strong show of dissent by the public against ACA and other corporatist legislature by our government, and/or a significant third party challenge.