Paul Levy's explantion of a possible design flaw in the proposed rules by which ACOs may be regulated is worth exploration.
It seems to me that the underlying problem is that many government policies intended to prevent constraints on competition just don't work well in the new paradigm of accountable collaboration. Is it possible that political realties make it impossible to achieve the needed combined goals of increased access, quality improvement and cost constraints? In light of national and global "graying," the reality is that as medical interventions become more successful people will live longer and costs will rise. It seems to me that there is an "impedance mismatch" between population-based healthcare and patient-centered medical care. On the one hand, when acute medical interventions become necessary we want assembly-line efficiencies. But on the other hand, we want to personalize care for each patient. Continuing discoveries involving DNA and genes can bridge the mismatch by allowing the creation of evidence-based protocols for very small groups of patients and even for specific individuals. But to do this the complexity of personalized diagnoses and treatments will increase dramatically, and with complexity the costs.