Editor’s note: This op-ed is by Ann Raynolds of Pomfret, a psychologist licensed in Vermont and New Hampshire.
Open letter to Vermont senior citizens on Medicare: Watch your mail closely. There’s a big new health care bureaucracy about to scoop you into it, not even asking for your approval to join. It’s called an “accountable care organization” (ACO) or OneCare. Not to join requires careful reading of the letter and then signing the enclosed “opt-out” notice, addressing an envelope, putting a stamp on the envelope and mailing this back (in my notice there was no addressed envelope enclosed). Whoever heard of this privacy infringement? Vermont law should protect us from that.
No one is told in the letter that this ACO includes almost all Vermont hospitals plus Dartmouth-Hitchcock Medical Center in New Hampshire. Who knows what this new behemoth Medicare bureaucracy is? And what’s wrong with an accountable care organization anyway?
Why is there a need for a profit motive in the delivery of health care? If we ran our police and fire departments on a profit motive, what would we have — competing licensed groups racing to fires, or police paid per suspect they caught?
An ACO is a for-profit new bureaucracy (with high administrative salaries) which if we don’t sign that “opt-out” letter, will have a monopoly to deliver health care services for all Medicare recipients in Vermont. Promoting better coordination in the delivery of health care as well as providing wrap-around follow-up services, the ACO concept is at first seductive. But we do not need a for-profit monopoly of our health care dollars in Vermont. And we do not need “Pay-for-Performance” (P4P) incentives for health care providers to coordinate care. Health care providers in an ACO would be competing among and between themselves to deliver less care – and yes, in the beginning at least they will be “monitored” by checklists, by having available less costly services. But consumers have little say; and in a few years with greed a rampant denominator in American society, who will regulate the many administrative safeguard checklists to assure care is not actually withheld from people? We’ve seen how ineffective regulators and regulations are on Wall Street; how teachers handle ill-conceived educational punishment/reward systems in Atlanta, how easy it is to circumvent our tax codes in offshore investments.
Why is there a need for a profit motive in the delivery of health care? If we ran our police and fire departments on a profit motive, what would we have — competing licensed groups racing to fires, or police paid per suspect they caught?
Since I am a health care provider, as well as a Medicare recipient, ideas for coordinating services, clinical conferences to determine best practices, cutting out duplication of services, teaching “wellness” and providing less expensive ancillary case manager services are admirable. But we do not need “profits-for-providers” (my definition for P4P) to do a better job spending our health care dollars. There is no reason health care providers would not do these things without a competitive profit motive. Put us on salary, allow us to spend dollars for wrap-around services, not have to bill fee-for-service only for face-to-face client time, and we will save health care dollars also.
One goal of ACOs is saving money through more flexible and preventive health care service. To save money in health care we need to look at just WHY procedures are so expensive, why hospitals charge so much for minor things like Band-Aids and ibuprophen; and how the for-profit insurance and pharmaceutical companies are already gouging the system.
How does this OneCare ACO fit with the single-payer “road map” in Vermont we heard so much about last year? In a single-payer health care system, the consumer of health care has a say through elected government officials; we have no say in OneCare, just as there is no say under our present for-profit health insurance companies. How can we be sure this OneCare operation can be blended into a not-for-profit single-payer health care system we’re committed to creating as soon as the federal government takes their heel off our necks? How could OneCare monopoly of Medicare dollars block our path to a single-payer health care system?
While it is quixotic to think enough seniors will read those letters, address an envelope, place a stamp on a letter and mail the “opt-out” reply, OneCare needs to do a better job explaining itself to seniors as well as explain why it was so unsure of its benefits to seniors that it did not choose to enroll people by an “opt-IN” rather than an opt-OUT letter.