The Silicon Valley of preventive care

The Silicon Valley of preventive care

Republicans ought to vigorously applaud Obamacare’s success,because it is using market incentives.

Republicans ought to vigorously applaud Obamacare’s success,because it is using market incentives

Unless you’ve been bamboozled by the frantic fictions of the right-wing,you know that the Affordable Care Act,familiarly known as Obamacare,has begun to accomplish its first goal: enrolling millions of uninsured Americans,many of whom have been living one medical emergency away from the poorhouse. You realise those computer failures that have hampered sign-ups in the early days — to the smug delight of the critics — confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognised it as a godsend and rendered it politically untouchable.

What you may not know is that the Affordable Care Act is also beginning,with little fanfare,to accomplish its second great goal: to promote reforms to our overpriced,under-performing healthcare system. Irony of ironies,the people who ought to be most vigorously applauding this success story are Republicans,because it is being done not by government decree,but almost entirely with market incentives.

Using mainly the marketplace clout of Medicare and some seed money,the new law has spurred innovation and efficiency. And while those new insurance exchanges that are now lurching into business will touch roughly 1 in 10 Americans (the rest of us are already covered by private employer plans or by government programmes like Medicare),these systemic reforms potentially touch every patient,every taxpayer. Since the Affordable Care Act was signed three years ago,more than 370 innovative medical practices,called accountable care organisations,have sprung up across the country,with 150 more in the works. At these centres,Medicare or private insurers reward doctors financially when their patients require fewer hospital stays,emergency room visits and surgeries — exactly the opposite of what doctors have traditionally been paid to do. The more money the organisation saves,the more money its participating providers share. And the best way to save costs (which is,happily,also the best way to keep patients alive) is to catch problems before they explode into emergencies.


Thus the accountable care organisations have become the Silicon Valley of preventive care,laboratories of invention driven by the entrepreneurial energy of start-ups. These organisations have invested heavily in information technology so they can crunch patient records to identify those most at risk,those who are overdue for check-ups,those who have not been filling their prescriptions and presumably have not been taking their meds. They then deploy new medical SWAT teams — including not just doctors but health coaches,care coordinators,nurse practitioners — to intervene and encourage patients to live healthier lives. Advocates of these reforms like to say that they are transforming medicine from the treatment of disease to the treatment of patients — and ultimately the treatment of populations.

This is not the heroic medicine that turns surgeons into gods and emergency rooms into Hollywood material. But these services address the embarrassing fact,reiterated in study after study after study,that Americans pay much more for medical care than other developed countries,with no better results. Obamacare addresses this problem by going,as Willie Sutton famously advised,where the money is. It concentrates resources on the unhealthiest.

What Obamacare has wrought is the kind of market-driven reformation that Republicans pretend to believe in. Which makes you wonder how much of their opposition rests on the merits,and how much is just a loathing for anything associated with Barack Obama.

Bill Keller