In particular, Catron discusses the numerous problems with the proposed new bureaucracies under ObamaCare, such as Accountable Care Organizations (ACOs). Here's an excerpt from his piece, "Cain, Cancer, and Obamacare":
The ostensible purpose of an ACO is to achieve high quality and efficient care by encouraging a group of hospitals, physicians, and other providers to work closely together on a particular population of patients. But, under the ACO rules proposed by Donald Berwick and his fellow bureaucrats at the Department of Health and Human Services (HHS), "quality" and "efficiency" will be measured in terms of money. "If the ACO is not successful it... is at risk of having to pay money back to CMS, and its participating providers may find that their own Medicare reimbursement is subject to recoupment by CMS."This creates perverse incentives for doctors and hospitals to skimp on care in order to chase the promised rewards from the government. Furthermore, Catron notes:
Another distinctive feature of Obamacare's ACO system is "blind assignment." Unless someone imposes some sanity on the proposed rules, it is entirely possible that you could be retroactively assigned to an ACO without even knowing it. This means, in theory at least, that your doctor could be prescribing care according financial imperatives of his ACO rather than your best interests. Will he hesitate to send you to a pricey specialist or think twice before sending you to the hospital for an expensive diagnostic test, like an MRI or a CT scan? Will your doctor temporize if your symptoms are ambiguous, as they often are for patients with colon cancer?(Read the full text of "Cain, Cancer, and Obamacare".)
There's a good reason that ACO's have been called "HMOs on steroids". But at least with HMO's, you knew in advance the deal you were getting. With ACOs, you might be unaware of the conflicts-of-interest your doctor faces when trying to juggling your medical interests with the demands of the ACO administration demanding greater cost savings.
As Megan McArdle noted in the 9/28/2011 Atlantic, the heavy-handed government approach inherent in the ACO concept explains why the "Poster Children for New Health Care Model Won't Participate in Model Program".
ACOs represent the old central-planner fallacy in a new guise. Fortunately, more Americans are waking up to this fact.
(And thank you, David, for citing FIRM and my earlier PajamasMedia piece in your article!)