Megan McArdle at The Daily Beast:
Last week, I wrote about the Cleveland Clinic, the widely respected medical center that the Obama administration hopes will become a model for health care system delivery under the new health law. Accountable Care Organizations are supposed to simultaneously lower costs and improve outcomes by streamlining and integrating delivery services. It’s a step towards the promised land that all health care wonks dream of, where we pay for health rather than treatment.
However, Cleveland, along with other model providers like Mayo and Intermountain, declined to become one of the ‘Pioneer ACOs’ that the Obama administration anointed to lead the way into the new promised land. And now, it seems, many of the institutions that did agree to join the wagon train are saying that they’ll pull out if the administration tries to, well, pay them for performance rather than treatment.
(…) So far, pretty much every one of those promised improvements has underwhelmed, and the skeptics have been vindicated. The deficit-reduction has been cut in half by the need to reform some ill-advised inclusions, such as a long-term health care program whose costs exploded just outside of the 10-year budget window, and a frankly crazy plan to make everyone in America issue 1099s to any vendor who sold them goods for cash.
Of course, predictions are hard, especially about the future. But I don’t think that the skeptics just got it right by accident. If health care reform were that easy, it wouldn’t be so hard.