How Accountable Care Organizations Came About

By Greg Scandlen

Thanks to the Freedom of Information Act, we were able to secure a transcript of this conversation that took place in a bunker deep underground in the Old Executive Office Building of the White House in 2009 —

Health Economist Joe: “Hey, Fred, whatcha working on?

Health Economist Fred: “Hi, Joe. I’m drafting the new health reform bill for President Obama and Nancy Pelosi.”

H.E. Joe: “Great! It is long overdue. We seriously need health reform.”

H.E. Fred: “Man, I’ll say. The health care system is a mess. Too many people uninsured, costs that are out of control, and quality that is questionable at best.”

H.E. Joe: “Yeah, but that has been the problem for fifty years. Every time we expand coverage or improve quality, the costs go through the roof. Or if we try to lower costs, people lose access and quality gets worse.”

H.E. Fred: “Not this time. We’ve solved that problem.”

H.E. Joe: “No kidding? How the hell did you do that?”

H.E. Fred: “It was easy. We’re going to create a new kind of organization that will take care of it.”

H.E. Joe: “You are? I’ve never heard of an organization like that. What do you mean?”

H.E. Fred: “You’re right. Such an organization has never existed, but it will this time.”

H.E. Joe: “Okay, what’s it going to look like?”

H.E. Fred: “Well, first it has to be interoperable. Next it has to be collaborative. And it certainly has to be high-performing and patient-centered. And of course it will be cooperative and evidence-based and involve all the stakeholders.”

H.E. Joe: “Ooooooh, I like it! Interoperable, collaborative, high-performing, patient-centered, cooperative, evidence-based, and involving all the stakeholders – how can it miss? Is there anything else?”

H.E. Fred: Of course, dummy. It must be also accountable. That is why we are calling it an Accountable Care Organization. That’s the most important thing.”

H.E. Joe: “Yep. There is nothing more important than accountability. But who will it be accountable to?”

H.E. Fred: “Me.”

H.E. Joe: “You?”

H.E. Fred: “Of course, you idiot. That’s how I’m going to keep this job until I retire.”