Emanuel on Accountable Care Organizations

Zeke Emanuel and Jeffrey Liebman are predicting that health insurance companies will vanish by 2020, to be replaced by the Accountable Care Organizations (ACOs) being called into being by President Obama's Affordable Care Act. ACOs, they predict, will practice more efficient medicine than the current fee-for-service system can generate, and will also replace insurance companies' risk-spreading function by pooling the risks of their higher- and lower-cost patients.

I can't share their optimism. Data from the five-year Medicare Physician Group Practice demonstration project casts doubt on the ability of ACOs to extract major savings from care-coordination. This Health Affairs Health Policy Brief on ACOs raises that question, and others as well: will ACOs form only in wealthier regions of the country, thus worsening already-existing health disparities? Could alliances among healthcare providers result in higher prices? Will ACOs run afoul of antitrust laws?

Of course we should do a better job of coordinating care; of course we should incentivize our doctors and hospitals to work on keeping people well rather than on intervening with expensive procedures after they're sick; of course we should use our better information technology to cut costs without cutting quality. Can ACOs do all of that? I sincerely hope so. But I'm not willing to bet that they'll be so successful as to make private health insurance obsolete in the next eight years.

Insurance Reform Successes

This report from the Centers for Disease Control shows that provisions of the Obama health insurance reform law which went into effect in 2010 have resulted in an additional 2.5 million young adults (19- to 25-year-olds) having insurance coverage. And while we're talking about provisions of the health reform law that are already helping people, let's not forget the reduced Medicare Part C premiums and the Medicare "doughnut-hold" drug rebates for the over-65 set; the no-copay, no-deductible preventative care; the low-rate "pre-existing condition" insurance pools that have allowed some seriously-ill people to find coverage; the tax credits for small businesses who insure their workers; the restrictions on insurance-company limits on what they'll spend on the seriously-ill; and the limits on health plans' ability to spend premium dollars on marketing and administration. All of these benefits are already flowing from Obamacare. If people knew what was in it, they might be less anxious to ask judges to strike it down.

Supreme Court to Rule on Health Reform

I'm a few days late with this, but here's the irreplaceable Timothy Jost's take on the US Supreme Court's grant of certiorari on a number of legal and constitutional issues related to Obama's health-insurance reform law.