Tuesday, August 2, 2016

An Obamacare Designer Confesses: "How I Was Wrong About ObamaCare"

Dr. Bob Kocher was special assistant to President Obama for health care and economic policy from 2009 to 2010.

He is out with an incredible op-ed at WSJ. In part he writes:
I was wrong. Wrong about an important part of ObamaCare.

When I joined the Obama White House to advise the president on health-care policy as the only physician on the National Economic Council, I was deeply committed to developing the best health-care reform we could to expand coverage, improve quality and bring down costs. We worked for months to pass this landmark legislation, and I still count celebrating the passage of the Affordable Care Act with the president one balmy spring night in 2010 as one of my greatest Washington memories.

What I got wrong about ObamaCare was how the change in the delivery of health care would, and should, happen. I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA. I joined my White House health-care colleagues— Ezekiel Emanuel and Nancy-Ann DeParle—in writing a medical journal article arguing that “these reforms will unleash forces that favor integration across the continuum of care.” We added that “only hospitals or health plans can afford to make the necessary investments” needed to provide the care we will need in a post-ACA world.

Well, the consolidation we predicted has happened: Last year saw 112 hospital mergers (up 18% from 2014). Now I think we were wrong to favor it....

What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.

Over the past five years, published research, some of it well summarized on a Harvard Medical School site, has indicated that savings and quality improvement are generated much more often by independent primary-care doctors than by large hospital-centric health systems....

Small, independent practices know their patients better than any large health system ever can. They are going up against the incumbent and thus are driven to innovate. These small businesses can learn faster without holding weeks of committee discussions and without permission from finance, legal and IT departments to make a change.

More often than not, one of the most important changes these practices make is embracing technology. The ability to store, analyze and make sense of data has now become so easy and inexpensive that all physicians can use “big data.”

In my White House days, we believed it would take three to five years for physicians to use electronic health records effectively. We were wrong about that too.

Got that? The medical central planner, Kocher, admits that he and the other central planners did not understand the market correctly. Despite ObamaCare doing everything possible to push medical care in the direction of mega-operations, the small operators have proven to be most efficient and with the best quality service.

This, of course, will come as no surprise to those who understand free markets and the impossibility of correct planning of a large economy, or major sector of it.

But here is the most shocking part of Kocher's essay. He has not given up on central planning of medical care, He continues:
Recognizing the strength in the small practices, the federal government needs to write rules that make it easier for them to thrive under ObamaCare and don’t tip the scales toward consolidation. That means introducing payment models that limit losses for small providers to the Medicare dollars they receive rather than total spending, and which rely on multiyear benchmarks instead of single-year swings. It also means comparing small practices to other small ones—instead of to large health systems with large balance sheets—when determining if a practice deserves bonus payments for savings.
The man doesn't get it. The hampered by regulation free market out did his planned medical care but instead of rejecting central planning of healthcare altogether and allow care to develop on its own on a free market, he wants to use a failed methodology, central planning, and apply it to the one sector that is succeeding because it has been free of such planning, with all sorts of new micromanaging of small providers.




  1. Once an organization grows to behemoth size, there is no incentive to progress and innovate. Worse than that, there are negative incentives to them. When they can no longer compete due to high prices and/or inferior product or service, that's when they turn to the government to create legislation and rules to keep the pesky competition at bay.

  2. Central planning is a mental illness at best or an evil urge to control everything at worst.

  3. NOBODY takes real life data and does an honest comparison of that data to their meticulous models, NOBODY.

    I work for a car company that started using analytical models of powertrain performance, fuel economy and all of that years ago. NEVER did they compare the output of what they designed using those models to the assumptions built into their models, NEVER.

    If hard core scientists and engineers don't do it why would we expect anyone in the "squishy sciences" (read "made up opinions") like central planning of the economy to subject their precious assumptions to such scrutiny? To do so would get in the way of making ever more ridiculous assumptions!

    Frankly, the whole damn world is intellectually dishonest on these issues. Being honest about the assumptions built into their damn models would mean that those assumptions would be challenged and perhaps tossed out in favor of better assumptions and NO central planning totalitarian could accept such a fate.

  4. .
    The Intent was Clear. Large Corporations gave political campaign contribution
    and paid large lobbyist fees to make sure the little guy was driven out of business.

    My physicians told me they were forced to join a group, the regulation and paperwork simply wasted too much time and expense.

    These groups just want you in and out as quickly as possible. They could not care a wit about you, volume is now the key. Not only the doctors but the staff all complain to me, when I said recently said how is it 9:30 a.m. and there is already an hour waiting time for a blood test.

    The intent was to drive all business to large corporations and force doctors to join them.
    . """" Small, independent practices know their patients better than any large health system ever can. """"

    Every one knows this. He pretends he did not ? This is some awakening ?