What happens with the population medicine approach (PMA) when one considers how thing really work according to the insights of public choice theory (PCT). Spoiler alert-you get much more cronyism,favoritism,and focused benefits and diffused costs with certain special interest groups profiting greatly.
Considering what went on with the writing of ACA what groups would be likely to profit from a governmental run PMA? Big Pharma,big health care insurance , big hospital system,big prescription drug management companies,and lots of consultants who will claim to be able to explain it all.
Recall some of the details of the profitable,magical revolving doors that were prominent in the creation and the subsequent development of The Affordable Care act.
Leading the list has to be Nancy DeParle.See here for Dr Roy Poses's comments on her travels in and out of business and in and out of prominent roles in government.
Senator Max Baucus's chief counsel,Liz Fowler, was singled out by the good senator for her important work in crafting the ACA. See here for my earlier comments about the ins and outs of her moving from health related business to Baucus' influential committee and back again.
More recently is the interesting matter of the new deputy administrator of CMS,Andrew Slavitt,who assumed that post fresh from his executive position at Optum/QSSI, a subsidiary of the country's largest medical insurer, United Health Group. Optum was hired by HHS to set up the internet hub for Obamacare.The ethic "rule" that a person leaving a private organization to a governmental agency cannot interact in an official capacity with that firm for one year was waived in the case of Slavitt . See here for details.
Should anyone be surprised that a deputy administrator of CMS would become chairman of ABIMF Board of trustees.
M. Hackbarth ,JD was a deputy administrator of Healthcare finance
administration (the precursor organization to Center for Medicare
Services and until recently was the chair of the board of trustees of
the American Board of Internal Medicine Foundation (ABIMF).
anyone be surprised that Sam Ho, an executive Vice President of United
Health Care, severed on an Institute of Medicine Committee that was
charged to devise recommendations to the administration regarding what
elements should be included in the mandatory health insurance proposed
Answer to both- of course not.
all who should know better what coverages should be included in a
program that forces everyone to buy health care insurance than the CEO
of an insurance company who will make out like crazy when the bill is
After all why would one of the hierarchy of the largest
third party payer ( ie Medicaid and Medicare) not wish to associate with
a foundation that strives to conserve the nation's health resources?
these are not instances of strange bedfellows but rather folks
synchronizing and harmonizing their mutual interests? All these folks
are just dedicated to providing quality health care to everyone while
wisely making choices that will preserve our finite medical resources.
anyone be surprised that a former vice president of a large medical
insurer (WellPoint) was the key author of the Obamacare bill as it came
out of Senator Baucus's committee? Of course not. who would be better
qualified for that task than Elizabeth Fowler who was also chosen by the
administration to oversee the administration of the statute after it
So what does all of this have to do with PMA and PCT? The history of the cahoots and cronyism of ACA provides the answer.