Accountable Care Organizations and Collective Farms


By Alieta Eck, MD, President, AAPS

Proponents of the Affordable Care Act (ObamaCare) claim that doctors in the US spend four times more, interacting with the many health plans, than Canadian physicians spend interacting with the government.

In 2009, physicians in Ontario spent $22,205 on administrative costs per physician per year, while US physicians spent a staggering $82,975 each trying to get insurance companies to pay them. U.S. nursing staff, including medical assistants, spent 20.6 hours per physician, per week, interacting with health plans, nearly 10 times that of their Ontario counterparts. Many health policy makers conclude that a centralized system would be more efficient. But would that be better for patients?

Section 1104 of the Affordable Care Act of 2010 instructs the Secretary of Health and Human Services to figure out ways to simplify interactions between providers and health plans. Instead of private practices, the reform bill supports new groupings of physicians in Accountable Care Organizations (ACOs).

In a bureaucrat’s heaven, ObamaCare will centralize payments to ACOs where care would be controlled and physicians compensated according to strict government guidelines, including dollars saved by giving less care. Patients would be expected to do what they’re told.

If physicians were farmers and patients were livestock, this might be feasible, but setting up an efficient assembly line system is not the way to provide compassionate, individualized high quality medical care.

As a matter of fact, even farmers and livestock did not do well with central planning of the collective farms that existed in the early 20th century in the Soviet Union. These were farms or groups of farms organized as a unit and managed and worked cooperatively by a group of laborers under State supervision. Private ownership of farms was no longer allowed and they were confiscated by the State.

The State promised to collect the meat and produce and distribute it fairly. But this did not happen and peasants, those who worked the hardest, lamented that they were not getting their fair share. When they revolted, their non-compliance was met with harsh retaliation, and life was reduced to stark subsistence.

People were forced into hard labor by cruel taskmasters as the supervisors were held accountable for the results. Lives were micro-managed by the central planners and freedom disappeared. The punishments became harsher when productivity declined. Eventually, it has been said that the people pretended to work and the State pretended to pay them. The Soviet Union fell under its own weight as the economy ground to a halt.

So do we need more centralized control in medical care? Or would decentralizing care and minimizing the middle man be even better?

American physicians and patients value independence, wanting to keep their interactions at a personal one-on-one level. Why not allow every patient to choose his own primary care doctor, keeping his phone number on speed-dial. When the patient wakes up with abdominal pain or blood in his urine, he should be able to pick up the phone, hear a familiar voice and make an appointment for the same day. At the end of the visit, he would pull out his check book or credit card, and pay a reasonable fee– about the cost of an oil change plus new windshield wiper blades. In 90% of medical visits there should be no third party and NO administrative costs.

Many US physicians have allowed themselves to be swallowed up by a system that is extraordinarily complicated and costly. But others are beginning to see that the answer is to pull away from all third party payers and contract with individual patients. Each doctor saving $83,000 per year would result in lower fees for the patients. Physicians would experience the great satisfaction of having an ongoing relationship with their patients, providing quick, efficient, and competent care. After all, that is why we went to medical school.

The Accountable Care Organizations will be the medical version of Soviet collective farms. The Affordable Care Act must be repealed before it has a chance to ruin the best medical care in the world.

Alieta Eck, MD, President of AAPS, graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO. She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care. She testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States. In 2003, she and her husband founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses. Dr. Eck is a long time member of the Christian Medical Dental Association and in 2009 joined the board of the Association of American Physicians and Surgeons. In addition, she serves on the board of Christian Care Medi-Share, a faith based medical cost sharing Ministry. She is a member of Zarephath Christian Church and she and her husband have five children, one in medical school in NJ.

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