ObamaCare Architect Admits Mistake

There’s an absolute bombshell of an editorial in today’s Wall Street Journal and I almost guarantee you it will go unnoticed by the MSM and, thus, sadly, most of the country. The piece was written by Bob Kocher, one of the primary architects of Obamacare and the only physician on the National Economic Council at the time of the law’s passage. While Dr. Kocher reminisces in the op-ed piece about the celebratory mood at the Rose Garden ceremony for the signing of the ACA, he wrote the piece to acknowledge one of its main failures. Here’s the upshot of Dr. Kocher’s cleansing confession: big is bad. Yes, that’s right, it took the left completely reconstructing our healthcare system to figure out that large organizations are less nimble, have more barriers to change, and waste more time and money than smaller ones. Wow. Only a true government wonk could ever have believed the opposite is true. Even my uber liberal sister once said to me that any time you get more than about 8 people together in one place, the group starts to get dysfunctional. Anyone who has ever worked for a large company or law firm or served on their church vestry or volunteered on a non-profit board, knows that truism. But, it took the Obama administration six years and literally trillions of dollars to figure it out. It’s nice that Dr. Kocher has admitted this mistake, but it’s a little late for all the patients who will suffer.

In case you don’t read the WSJ or are too lazy to look it up, the details of Dr. Kocher’s admission go something like this. When the Obamaites crafted the ACA, they knew it would lead to massive consolidation in the delivery of healthcare into huge integrated systems. They were right about that and it was, indeed, by design. He pretends (or was duped into believing) this construct was because they believed large highly integrated organizations would lead to efficiencies and cost savings. Again, only a liberal ideologue of the worst sort could believe that making an organization larger and more bureaucratic would simultaneously make it more efficient. I suspect the more likely reason for encouraging this consolidation is the intent to create a national health system. In order to achieve that goal, which the left has had for a long time, the first step is consolidation. It’s a lot easier for the government to take over a few very large organizations than thousands of small ones.

The ACA performed as its designers intended. Dr. Kocher tells us that 112 hospitals merged in 2015, up 18% from 2014. I sit on the board of directors of a medium-sized hospital system in the mid-Atlantic. Since the ACA passed, our system has acquired numerous physician practices, a radiology practice, and opened stand-alone clinics. As Dr. Kocher articulates in his opinion piece, the results of the consolidation created by the ACA have been poor. Here are just a few quotes from his article. Recall, this is the liberal architect of Obamacare:

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 more often by independent primary-care doctors than by large hospital-centric health systems.

Small, independent practices know their patients better than any large health system ever can…These small businesses can learn faster without holding weeks of committee discussions and without permission from finance, legal, and IT departments to make a change.

These quotes made my head spin. I simply cannot believe that a fully grown adult was surprised that a large organization took longer to make decisions than a smaller one. And, how many times did Republicans warn that Obamacare would drive wedges between patients and their doctors who knew them best. And, that this would lead to more expensive, lower quality care. I take no joy in saying, “I told you so,” but I told you so. There’s no joy in being right here because liberals have now created a more expensive, less efficient system that is providing worse care to patients. And, please note that these words are not mine; they are from the one physician that worked on the design of Obamacare.

Dr. Kocher concludes his piece with two comments. First he says,

Personal relationships of the kind found in smaller practices are the key to the practice of medicine.

And, finally,

Recognizing the strength in 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.

I actually give Dr. Kocher a lot of credit. It’s not often government wonks screw up and admit it. But, I have a much better idea. How about instead of “writing rules,” the federal government gets the hell out of the way and let the market work, like they should have in the first place. They’ve done enough damage already. What we really have here is a chief architect of the system saying, at least implicitly, repeal and replace.

Much of the media attention on the November election has been focused on the economy, foreign policy, and immigration. That’s appropriate because Obama/Clinton have made a mess of all three. However, our future depends on having a functioning healthcare system and we now have a key liberal admitting their mistakes. It’s time to get rid of their mess and start over. Donald Trump has promised to do just that.

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About Bruce Robertson

Bruce Robertson is an amateur writer and professional provocateur
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One Response to ObamaCare Architect Admits Mistake

  1. Well, I have to agree with you. Small practices are definitely better. Unfortunately, there has been massive consolidation of medical practices, and as far as I can tell, it started way before Obamacare was even a twinkle in its daddy’s eye. Indeed, I reckon it was the beloved market forces that brought on this consolidation: you can make much more money that way, and there are economies of scale (which, I assume, is why there are hospitals in the first place, rather than appendix surgery centers, spleen surgery centers, etc.).

    I hope Obamacare does find a way to encourage small practices to thrive, as the author of the WSJ piece (who by the way is now a venture capitalist) suggests. Market forces had certainly been driving in the other direction before.

    As a final note, Bruce, I would note that I agree with you and your sister that groups of over 8 members get messy fast. That is why I was so pleased that our insurance companies all were limited to 8 employees before the ACA passed. I had Aetna in those days, and I actually got to know all 8 Aetna employees – the service was incredible.

    Before OC, the health insurance system was horrible for many Americans. OC is an improvement for millions. Is it perfect? Not yet. Will it get better? That’s the idea.

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