Thank you to the Will Cain Show for having me on to discuss why the Affordable Care Act has driven up healthcare costs in America. It’s pretty simple: The ACA gave tremendous market power to health insurers and corporate medicine including large health systems making it difficult for private practices to compete. It imposed regulatory, documentation, and reporting burdens making private practice viability increasingly difficult. Only 25% of physicians remain independent now with the rest employed by corporate medicine. The ACA also banned physician owned hospitals which have been shown to provide care at lower cost with higher patient satisfaction scores. The unfortunate end result: Massive healthcare consolidation resulting in less competition. And a basic economic principle is that less competition results in higher prices. We need to restore free market forces to fix the cost crisis in US healthcare and level the playing field to encourage competition. Bring back private practice. Bring back physician owned hospitals. This is what our patients deserve. #PrivatePractice #HealthcareReform #HealthcareConsolidation Scott Becker Adam J. Bruggeman, MD, MHA, FAAOS, FAOA Dutch Rojas
Congrats Dr. Choi on being asked to participate on this show. I completely agree about the challenges you identify facing physicians about consolidation leading to loss of private practice but I am also concerned about the attribution solely to the ACA (as opposed to one of many factors) is giving fodder to those who oppose extending insurance subsidies. MSSNY has joined with many other medical societies and the AMA in supporting extending these subsidies).
The problem the insurers exploited was access to care. The vast majority of private practices in Ortho and Spine did not “accept” Medicaid and unfunded patients. It also addressed the nefarious “preexisting condition” exclusions used by insurers to deny care. I doubt the access issue will go away without provisions to support the poor. I don’t see elective practices welcoming the groups they excluded previously with reimbursements at this all time low for insured patients. Free market without open access isn’t really free. I don’t know what “Trump Care” consists of but given these past 10 months- I’m not holding my breath.
Kip Sullivan reviews the Dartmouth Atlas and assumptions, which have set us back decades. Links to four important blogs are included. It is very important to understand the Dartmouth distortions since the people and the process and the training and the apprenticeships and the conferences and the profits will continue to result in same or worse than Obamacare designs The faulty risk attribution, the assumption that 20% of the population reflects the 100%, added costs of micromanagement, added burdens of micromanagement will continue Cost cutting continues and harms most Americans most behind Quality micromanagement continues and discriminates against those serving most Americans because they are inherently most behind Expansions of worst quality health insurance is not a help where the public and private plans are the worst Quality of care is about relationship, not metrics Primary care practices are not resourced to address - by design Care coordination is prevented by half enough workforce, team members, resources https://www.linkedin.com/pulse/decline-assumption-based-designs-robert-bowman-ys3dc/
Honest question. How do you achieve value based outcomes when the individual has so much control (examples actually doing PT, taking meds as prescribed, changing diet and exercise) over the outcome? This seems to be the elusive piece.
Your perspective highlights how consolidation reshapes care delivery, and restoring real competition feels essential for a system that genuinely serves patients.
The biggest problem with the ACA was the pork the insurance companies wrote in for themselves since they essentially wrote the law. I mean, what *could* go wrong? SMH
Great job Dan! The ACA has been a tremendous wealth transfer to insurance companies to the detriment of independent physicians and patients. It’s past time to fix the issues!
There are very few leaders and thinkers as sharp as Daniel Choi Dr Choi we need you as a keynote speaker in June!!!! Laura (Miller) Dyrda Virginia Egizio, CMP Jessica Cole
Congratulations! Hard to compete with $565m/year lobby of big Healthcare and and 6-9 lobbyists per congressman. Maybe if we ban lobbyist we'd have a slim chance.
While I agree with the negative impact of healthcare consolidation and what it has done to independent practices, blaming this on the ACA is misguided. The ACA was designed to do three things: strengthen consumer protections in the health insurance marketplace, increase the total number of people insured, and help to develop value-based care models in CMMI. It succeeded on the first two items, and failed on the third. Value-based care is still a good idea, but creating models that require expansive controlled vertical networks and huge capital reserves has reinforced healthcare consolidation--which was occurring long before the ACA was passed. The capital requirements spawned the private equity entry into healthcare, which in my view has been an unmitigated disaster. Going forward, we need to reinforce the first two elements of the ACA, and create models in CMMI that emphasize independent primary care doctors. We are still spending less than 5% of total expenses on prevention and primary care. That is what doctors like Dr. Choi should be promoting, not right-wing talking points linking the ACA to every malady in our dysfunctional health care system.