How I Was Wrong About ObamaCare

[Theo520]

This is a good article by one of the drafters of Obamacare, on why the law has failed to deliver

How I Was Wrong About ObamaCare
The law’s drafters wanted consolidation: 112 hospital mergers last year. But smaller practices have improved care better.

I was wrong. Wrong about an important part of ObamaCare.

When I joined the Obama White House to advise the president on health-care policy as the only physician on the National Economic Council, I was deeply committed to developing the best health-care reform we could to expand coverage, improve quality and bring down costs. We worked for months to pass this landmark legislation, and I still count celebrating the passage of the Affordable Care Act with the president one balmy spring night in 2010 as one of my greatest Washington memories.

What I got wrong about ObamaCare was how the change in the delivery of health care would, and should, happen. I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA. I joined my White House health-care colleagues— Ezekiel Emanuel and Nancy-Ann DeParle—in writing a medical journal article arguing that “these reforms will unleash forces that favor integration across the continuum of care.” We added that “only hospitals or health plans can afford to make the necessary investments” needed to provide the care we will need in a post-ACA world.

Well, the consolidation we predicted has happened: Last year saw 112 hospital mergers (up 18% from 2014). Now I think we were wrong to favor it.

I still believe that organizing medicine into networks that can share information, coordinate care for patients and manage risk is critical for delivering higher-quality care, generating cost savings and improving the experience for patients. What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.

Over the past five years, published research, some of it well summarized on a Harvard Medical School site, has indicated that savings and quality improvement are generated much more often by independent primary-care doctors than by large hospital-centric health systems.

Look at accountable-care organizations (ACOs), in which doctors and health-care providers come together to provide complete care for an individual and are compensated for keeping them healthy and generating savings. Based upon the latest data the Centers for Medicare and Medicaid Services has released,from 2014, independent physician-led ACOs, like the Rio Grande ACO on the Texas border, are outperforming ACOs from many of the most famous health systems. Johns Hopkins Hospital in Baltimore has been ranked as one of the top three health systems in the nation, but its ACO failed to achieve shared savings in 2014.

Small, independent practices know their patients better than any large health system ever can. They are going up against the incumbent and thus are driven to innovate. These small businesses can learn faster without holding weeks of committee discussions and without permission from finance, legal and IT departments to make a change.

More often than not, one of the most important changes these practices make is embracing technology. The ability to store, analyze and make sense of data has now become so easy and inexpensive that all physicians can use “big data.”

In my White House days, we believed it would take three to five years for physicians to use electronic health records effectively. We were wrong about that too. At every opportunity, organized medicine has asked to delay and lower thresholds for tracking and reporting basic quality measures; yet they have no reason to delay.

In the ACOs run by Aledade, which advises small medical practices (I sit on its board), we have found that independent primary-care doctors are able to change their care models in weeks and rapidly learn how to use data to drive savings and quality. For small practices, it does not take years to root out waste, rewire referrals to providers who charge less but deliver more, and redesign schedules so patients can see their doctors more often to avert emergency-room visits and readmissions.

Recognizing the strength in the small practices, the federal government needs to write rules that make it easier for them to thrive under ObamaCare and don’t tip the scales toward consolidation. That means introducing payment models that limit losses for small providers to the Medicare dollars they receive rather than total spending, and which rely on multiyear benchmarks instead of single-year swings. It also means comparing small practices to other small ones—instead of to large health systems with large balance sheets—when determining if a practice deserves bonus payments for savings.

Large health systems deliver “personalized” care in the same way that GM can sell you a car with the desired options. Yet personal relationships of the kind often found in smaller practices are the key to the practice of medicine. They are the relationships that doctors want to forge with patients, and vice versa. It may sound old-fashioned, but what I have learned is that we do not need to sacrifice this unique feature of our health-care system as we move forward in adapting new value-based payment models and improving the health of patients.

Dr. Kocher was special assistant to President Obama for health care and economic policy from 2009 to 2010. He is now a partner at Venrock, the venture-capital firm.

 

[1neophyte]

It’s always irritating when someone admits that they were wrong about something that any moderately thinking person could have gotten right in the first place, and it’s already too late.

 

[ChurchSoldier]

Well said.

 

[Theo520]

This is a good article by one of the drafters of Obamacare, on why the law has failed to deliver

Interesting facts

• The author was Special Assistant to the President for Healthcare and Economic Policy
• he was the only MD on the advisory team for ACA
• He was a newly minted MD with less than a decade of experience to share.

Bad policy will usually result when the team writing it has an agenda but lack relevant experience

 

[DeniseNY]

It’s always irritating when someone admits that they were wrong about something that any moderately thinking person could have gotten right in the first place, and it’s already too late.

The country was royally Grubered.

 

[ClearWater]

It’s always irritating when someone admits that they were wrong about something that any moderately thinking person could have gotten right in the first place, and it’s already too late.

Let’s be civil.

 

[TCEL]

Odd. Last night I quietly complained about the Leviathan of healthcare to my husband because I hadn’t heard back from anyone about getting a prescription refilled, and said medicine ran out several days ago. I’ve contacted twice. It isn’t supposed to be this impersonal. Now, don’t mistake me, I’m not ungrateful for what I have, but that doesn’t mean we should settle when there are better ways.

 

[FghtinIrshNvrDi]

Well howdy-do.

The whole thing was designed to fail, increase costs, and be frustrating for everyone to try to get care through the system. That way we’d all clamor for a centralized, fully communist system.

 

[TCEL]

Well howdy-do.

The whole thing was designed to fail, increase costs, and be frustrating for everyone to try to get care through the system. That way we’d all clamor for a centralized, fully communist system.

I guess I’m recalcitrant. I would prefer a small practice. I like my kid’s pediatrician for that reason.

 

[FghtinIrshNvrDi]

I guess I’m recalcitrant. I would prefer a small practice. I like my kid’s pediatrician for that reason.

You & me both. Human to human.

 

[ProdglArchitect]

I think the most surprising thing about this is that this man found any of these findings surprising…

 

[Theo520]

Let’s be civil.

I thought he was extremely civil considering Competition law theory is universally accepted in the developed world. Heck, it’s the basis of our anti-trust laws.

Where we are is 100% predictable based on what’s in the ACA law.

 

[Erich]

 

[1neophyte]

Let’s be civil.

How on earth is that not civil? Profanity? Name calling? Since when is making an observation not civil? How many truly evil or simply incorrect things are allowed to go on because it’s not “civil” to point out they are evil or incorrect?

 

[JimR-OCDS]

Well, I was on Romney Care which then became Obamacare.

I have had the same doctor for the past 25 years while I was employed and I still have the same doctor and little has changed other than technology.

Also, my doctor is part of a small medical group and they will continue to be part of that small medical group. They are also attached to a large hospital healthcare group under U-Mass Medical.

In all its been excellent.

So, the article in the OP doesn’t fit my experience and throughout Massachusetts, most physicians are part of small medical groups which are attached to larger hospital groups like Tufts or Harvard Medical.

Individual physicians can not afford to be on their own these days and it has nothing to do with Obamacare, but the fact that a physician needs the technology which being part of a medical group provides.

When I go for my physical, my blood work results are done within a day and I see the results on my health page which U-Mass Alliance runs.

When my wife ended up in the ER bent over in pain, they sent her for a CAT scan. Our doctor, in the next city got the results as soon as the tech was finished and he saw she need surgery to have her gall-bladder removed. He immediately had us set up with a surgeon in the same building and within 4 hours, she was in her room recovering from surgery.

All this new technology was coming and any physician who tries to stay on his own, will end up out of business.

Jim

 

[St_Francis]

Well, I was on Romney Care which then became Obamacare.

I have had the same doctor for the past 25 years while I was employed and I still have the same doctor and little has changed other than technology.

Also, my doctor is part of a small medical group and they will continue to be part of that small medical group. They are also attached to a large hospital healthcare group under U-Mass Medical.

In all its been excellent.

So, the article in the OP doesn’t fit my experience and throughout Massachusetts, most physicians are part of small medical groups which are attached to larger hospital groups like Tufts or Harvard Medical.

Individual physicians can not afford to be on their own these days and it has nothing to do with Obamacare, but the fact that a physician needs the technology which being part of a medical group provides.

When I go for my physical, my blood work results are done within a day and I see the results on my health page which U-Mass Alliance runs.

When my wife ended up in the ER bent over in pain, they sent her for a CAT scan. Our doctor, in the next city got the results as soon as the tech was finished and he saw she need surgery to have her gall-bladder removed. He immediately had us set up with a surgeon in the same building and within 4 hours, she was in her room recovering from surgery.

All this new technology was coming and any physician who tries to stay on his own, will end up out of business.

Jim

Good to know that Romney care worked for you, under circumstances which are very different from the US as a whole. Not everyone has had a good experience like yours.

 

[Kenny_Kamel]

Well howdy-do.

The whole thing was designed to fail, increase costs, and be frustrating for everyone to try to get care through the system. That way we’d all clamor for a centralized, fully communist system.

I am wondering if it were ever supposed to be about healthcare at all, ACA/Obamacare has been used a vehicle to assault religious freedom as much as anything and that has lead to the steamrolling imposition of many other Obama agenda items in no way related to healthcare.

Obamacare had been a massive failure insofar as healthcare improvement is concerned.

Obamacare has been a massive success insofar as other Obama agenda priorities are concerned.

 

[JimR-OCDS]

Good to know that Romney care worked for you, under circumstances which are very different from the US as a whole. Not everyone has had a good experience like yours.

Well. I know others from other parts of the US who also have had good experience.

Obamacare is nothing more than a place to buy affordable health insurance.

The insurance companies are still calling the shots on many things, so there is a problem with this aspect.

The places where Obamacare is not working, seems to be in the Red States which rejected Obamacare and have fought against it since it became law. The politicians in those states are making their own people suffer, in order to get support to repeal Obamacare.

Well. it isn’t going to happen, especially if Hillary becomes president.\

If Trump by some miracle becomes president, he wants to replace it with a single payer system, which is what we should’ve had in the first place

Jim

 

[JimR-OCDS]

I am wondering if it were ever supposed to be about healthcare at all, ACA/Obamacare has been used a vehicle to assault religious freedom as much as anything and that has lead to the steamrolling imposition of many other Obama agenda items in no way related to healthcare.

Obamacare had been a massive failure insofar as healthcare improvement is concerned.

Obamacare has been a massive success insofar as other Obama agenda priorities are concerned.

Well, the only religious freedom aspect came after Obamacare was law, and HHS tried to remove religious exemptions in paying for contraceptives. Obama himself had promised Cardinal Dolan that the exemptions would be there. After a heated battle with WH staff and HHS Secretary, Obama caved in and gave them most of what they wanted.

Of course its now going in circles through the Supreme Court.

So, Obamacare was not passed under a anti-religion agenda.

Heck, even the Bishops supported Obamacare, if they got the religious exemptions they asked for.

Jim

 

[Theo520]

Well. I know others from other parts of the US who also have had good experience.

Obamacare is nothing more than a place to buy affordable health insurance.

The insurance companies are still calling the shots on many things, so there is a problem with this aspect.

The places where Obamacare is not working, seems to be in the Red States which rejected Obamacare and have fought against it since it became law. The politicians in those states are making their own people suffer, in order to get support to repeal Obamacare.

Well. it isn’t going to happen, especially if Hillary becomes president.\

If Trump by some miracle becomes president, he wants to replace it with a single payer system, which is what we should’ve had in the first place

Jim

Jim, any comments on what’s stated in the OP on how ACA is impacting the market? Are you disputing the author, who helped craft ACA?