Who is Accountable in Accountable Care Organizations?


By: Alieta Eck, MD,

Part of the scheme of ObamaCare is to set up Accountable Care Organizations. In New Jersey, they are being set up for the Medicaid population. As is typical of all “innovative” government programs, they might seem good on paper but are really nothing new. They may appear to solve problems in the old Medicaid system, where physicians are so underpaid that few enroll, but new problems and cost overruns will inevitably occur.

Accountable Care Organizations (ACOs) are a rehashed version of the failed closed HMO model of the 1970s and 80s, where the government poured millions of dollars into private enterprises that supposedly were rewarded when they kept the patients well. Once the federal dollars dried up, these entities failed under the heavy weight of their own bureaucracy and the insatiable demand for the free care that was expected. The administrators of these failed entities stashed away their generous salaries and have now retired to warmer climates. Now their successors are trying to resurrect the model, figuring that those who remember the central Jersey RCHP (Rutgers Community Health Plan) will not remember why it failed.

The purpose of good medical care is to make the patient whole– to diagnose disease as early as possible and to develop a treatment strategy to allow the patient to live an independent, happy and productive life. The purpose of good health care is to minimize the need for more health care.

Instead, we have created an underclass of people dependent on Medicaid, one in eight New Jersey residents. It is hard to fathom that one in eight New Jersey residents need government to care for them. Instead of being a nation of hard-working independent citizens, we have increasingly become a nation of people with their hands out. Have we forgotten our American roots?

How can our citizens have a sense of accomplishment when the government is doing for us what we ought to be doing for ourselves? Of course, we all know that some are poor through no fault of their own, but one in eight? Something is dreadfully wrong here.

The problem with the setting up of Medicaid ACOs is that they are attempting to make the physicians accountable for the behavior of many who have a tendency to make poor choices and be rather irresponsible and unaccountable. The person who ought to be most accountable should be the patient himself, yet these systems go on the assumption that this is an impossible dream.

Medicaid recipients pay nothing for their health care, but are told they are entitled to free care. People on Medicaid are twice as likely to show up at the ER than to see their own doctor. Why make an appointment and wait for care at a private physician office when the hospital is staffed 24/7 and Medicaid will pay for a cab to get him there? From 2002-2007, poor patients visited the ER 12,600 times for head colds, 7,700 for ear infections and 7,600 times for viral infections. This is unaccountable behavior.

Government medicine never seems to chide the patient for his over-indulgences, but rather enables him to magnify symptoms that will keep him on the public dole. People on Medicaid often fear the day when they get well or find a job as the “benefits” will end.

Medicaid is an irresponsible waste of money, and unfair to the taxpayers who must foot the bills. The taxpayers are hit with a bill of $10 billion for Medicaid in NJ where the total state budget is $33 billion. And ObamaCare promises to increase the Medicaid rolls even further.

Many physicians are ready to make a deal. Allow poor people access care in free non-government charity clinics run mostly by kind-hearted volunteers. Volunteer physicians would donate four hours per week to care for the poor. No entitlement, no billing, no claim forms, no CPT coding. Just kind, compassionate, free, uncompensated care.

As their only reward physicians would ask the state to provide medical malpractice coverage for their entire practices– the same coverage given to military physicians and those who teach in the medical school hospitals. No premium would be paid, but patients would be compensated by the state if a real injury occurred. This non-bureaucratic solution would provide a kinder and more adequate solution to help the poor overcome their poverty and would end the crushing tax load that stifles initiative. It could be morning in America once again.

Alieta Eck, M.D. 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.


  1. This is all too true as most of us realize. Not only are the physicians accountable, but we are accountable to achieve a goal of continuously lowering our total annual cost–also an impossibility, as there is obviously a minimum reasonable cost with maximum “efficiency.”

    I appreciate the offered solution of free clinics. I think this is very wise and plausible. Could we also add in reimbursement of student loans for us young ones? Obviously, questions would arise pertaining to more advanced procedures, but I think they could also be handled under the “volunteer time, get malpractice coverage” theory. However, facilities, etc… How much would it cost for Medicaid to cover facilities for this vs. the savings in ER visits/ unnecessary healthcare. I have a feeling we’d all still be saving. Let’s take back medicine!

  2. Will doctors, especially those beholden to government money, repeat past errors and expect different results? Stay tuned…………………..

  3. We should abolish medicaid — and every other unconstitutional agency. Get people off the dole. We are each responsible for our own lives. We’ll be healthier and happier.

  4. Our main hospital, located in an affluent community, is gearing up for ACOs. They are busy collecting “forms” that the patient signs and answers questions on exercise diet etoh use etc. Many patients are not happy with this intrusion from the insurance co. I find it repetitive and more work for my staff taking away from care. We also have an organization starting to try to combat the ACO locally. They have a budget of $80,000+ and are asking for donations from the docs. What advice do you have to deal with the ACO issue locally?

  5. Dr Eck,

    Thanks so much for the article which I think is spot on, except for the last paragraph. Were did that come from? We can’t have our cake and eat it too. If we expect the government to get out of health care, which I totally believe, we have no right on the other hand to ask them to pay our malpractice insurance. If you do that, that puts them right back into private business with authority to dictate “how” we practice under the guise of “managing their risks – to keep the costs down”. No. We do desperately need tort reform at a state level.

    John Nolte, MD

  6. I agree with this approach. Many doctors have their own free system. Many patients can afford to pay for care that truly respects and inspires them. The government is busy shutting down practices under the undeserved label of “pill mills”. The federal government has no jurisdiction over the practice of medicine. I think the book on HSA’s was great and I handed them out for a while. Sincerely, Dr. Katy Hoover

  7. Jeanne,
    It is employers and their HR offices that decide annually which insurance companies to go with and what level of health care they will provide the next year. I’m going to start targeting patient’s that work at larger companies to petition their employer/HR personnel that they don’t want ACO (HMO) type health care and they want an out option offered.

    John Nolte, MD

  8. i agree that medicaid needs reformed. those on medicaid should not be encouraged to remain there and to continue having children out of wedlock, while the fathers con’t to feed off the pregnant women. Generation after generation using medicaid as a life style. Why can’ t it be changed to one child only? Don’t pay after this one. Us course, I think, when Obama spreads the wealth, he’ll have us all holding that card.

  9. Dr. Eck’s proposal would benefit all New Jerseyans: tax payers, impoverished patients, and NJ physicians in private practice willing to donate their services to help the poor. If the State of New Jersey indemnifies physicians’ practices in exchange for participation in a “Free care for the poor” program, no monies will be spent unless malpractice claims are made. Additionally, if the State of New Jersey indemnifies participating physician practices, the number of frivolous law suits in our state would diminish, and caps on med-mal claims would be implemented.
    I hope to see the day that this wonderful plan becomes reality, to eliminate Medicaid and help the poor.

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