New Krugman piece - The Medicare Miracle

[WFU71]

The Walmart analogy might be close to the truth. My knowledge of ACO's is limited, so the following could be off base.

ACO's can save some government money, but will also probably screw the small providers (doctors, nursing homes, and such). The main provider (hospital system?) gets a lump some and contracts with the smaller providers at a price likely lower than what those providers currently get. Of course, those small providers will be fighting to get whatever scraps they can get from the ACO in order to stay in business.

The ACO gets stronger, the other providers get weaker, and the government will ultimately need the ACO, due to the lack of competition, as much as the ACO needs the government.

 

[WFU71]

You're probably doing something right if Glen Beck calls you the second most dangerous man in America. Dug this read.

Ahh, the death panel guy.

 

[WFU71]

A pretty good discussion of ACO's. http://online.wsj.com/news/articles/SB10001424052970204720204577128901714576054

I would tend to agree with Tom Skully:

"The biggest flaw with ACOs is that they are driving more power to hospitals—not to doctors. Very scary, and I am a hospital guy. The goal of ACOs was to organize doctors to focus more on patients and keep the patients out of hospitals. Instead, doctors are selling practices to hospitals in droves.

The start-up cost of a real ACO is probably $30 million and up in a midsize market—and doctors don't have that capital. So hospitals are pitching that they will be ACOs, and buying up practices. Ever meet a hospital administrator who wants to work to empty his beds? This means more power in expensive institutions, more consolidation of those giants—and more bricks and mortar and more costs. And with zero antitrust enforcement in the last 30 years in the hospital world, we are cruising for regional hospital-based oligopolies—not good for doctors, patients or our hopes for a more efficient system. And the well-intentioned concept of ACOs is feeding that fire.

If the doctors had the capital to organize comprehensive ACOs to control their own fate and drive us to more efficient care, I would be bullish on ACOs. But doctors are again along for the ride, not driving the bus."