ObamaCare Adviser: We Were Wrong about Something Important

Quote of the Day:

I was wrong. Wrong about an important part of ObamaCare.

–Bob Kocher, former special assistant to President Obama on health care and economic issues

Bob Kocher was an adviser to President Obama and  the only physician on the National Economic Council. He can be counted as one of the designers of ObamaCare.  He still counts celebrating the passage of the Affordable Care Act "with the president one balmy spring night in 2010 as one of my greatest Washington memories."

But he now thinks that they got one thing very wrong. Kocher favored consolidation of doctors and hospitals into larger entities. He authored a medical journal article with Ezekiel Emanuel and Nancy-Ann DeParle–two other key figures in the development of the Affordable Care Act– arguing that “these reforms will unleash forces that favor integration across the continuum of care.” This pretty much came to pass–and now Dr. Kocher is saying, in effect, oops! He writes in today's Wall Street Journal:

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.

I still believe that organizing medicine into networks that can share information, coordinate care for patients and manage risk is critical for delivering higher-quality care, generating cost savings and improving the experience for patients. 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.

Oh, great–now he tells us.

Since the passage of the ACA, Dr. Kocher has noticed that independent, physician-led are doing a better job, both in terms of services to patients and savings, than the accountable-care organizations (ACOs) proposed by ObamaCare. In other words, these independent practices are more accountable that ACOs. The White House was unable to understand that these independent practices could adapt quicker and provide better medical care than the cumbrous ACOs. Kocher writes:

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

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. At every opportunity, organized medicine has asked to delay and lower thresholds for tracking and reporting basic quality measures; yet they have no reason to delay.

In the ACOs run by Aledade, which advises small medical practices (I sit on its board), we have found that independent primary-care doctors are able to change their care models in weeks and rapidly learn how to use data to drive savings and quality. For small practices, it does not take years to root out waste, rewire referrals to providers who charge less but deliver more, and redesign schedules so patients can see their doctors more often to avert emergency-room visits and readmissions.

The lessons learned by the good doctor are ones that advocates of free-market-based, patient-centered health care reform could have told him billions of dollars ago. But the Obama White House, knowing nothing about business and competition and eager to ram through ObamaCare with no input from Republicans, wouldn't listen.

After a great deal of pain and suffering, Kocher writes:  

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.

Not to denigrate Dr. Kocher, who has recognized and admitted a failure, but isn't there a better way to go than rewriting rules to a massive federal failure?

The next election determines whether ObamaCare will remain on the books in some form (to be tinkered with from generation unto generation) or whether we may have a shot at genuine health care reform based on something other than central planning and hubris.