By, Dr. Deborah Richter, Vermont for Single Payer Supporter
Legislators desperate to avoid addressing single payer have seized on a save-the-day concept. These are called ACOs, which stands for Accountable Care Organizations. What exactly are they? No need to ask your legislators because none will be able to explain ACOs in under 15 minutes or 10,000 words, if at all
ACOs propose to collect doctors, medical personnel and hospitals into regional groups.These groups, or organizations, receive a lump sum payment (from where? you may want to ask.) to care for patients (who volunteer or are assigned? you’ll want to ask).
Where it gets interesting is here: the operating assumption is that Vermont doctors – who deliver some of the best health care in the country according to national rating groups – are motivated above all by money. This being so, goes the theory, it is time to apply the old carrot and the stick. Both carrot and stick are money.
If doctors behave, medically speaking, “better” or more “efficiently” thereby saving on costs, they get to keep the money saved under the budgeted lump sum. That’s the carrot. If they don’t, if the costs of their delivery of health care exceeds the lump sum, they are out of luck. That’s the stick.
The goal is to influence the behavior of doctors in the direction of a healthier population which, it is reasonably assumed, will be a less medically costly population. (Another reasonable assumption is that that is what doctors do now, but we’ll skip over that.) So how will we know exactly? We create a deep layer of administrative bureaucracy in these ACOs to find out.
An accountant’s question might be: Is the layer of bureaucracy going to cost more than the savings on healthier people? No one knows for sure. There are suspicions. We’ve already experienced “managed care”. Medically speaking it led to some minor improvements but nothing like those envisioned by proponents. Fiscally speaking it led to the same or higher costs.
ACOs are experiments. They are unimplemented thought experiments with little supporting evidence. State legislatures are fond of experiments because it means they don’t have to do the truly hard work of health care reform. We are about the only nation left that is still putting its faith in untried experiments.
You can always identify these experiments because they all add costly administrative layers to existing health care services. And they are always done in the name of “efficiency” and “cost savings” which happen to be exactly the aims subverted by larger and larger administrative bureaucracies.