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June 6, 2012

If Accountable Care Organizations Are the Answer, Who Should Create Them?

Author Affiliations

Author Affiliations: Stanford Institute for Economic Policy Research, Stanford University, Stanford, California (Dr Fuchs); and University of Southern California, Los Angeles (Mr Schaeffer).

JAMA. 2012;307(21):2261-2262. doi:10.1001/jama.2012.5564

Public policy experts across the political spectrum agree that health care cost growth must be reduced to avoid major economic problems, including a federal deficit crisis. The need is urgent because the United States cannot continue to decrease funds to support education, postpone crucial maintenance and repair of infrastructure, potentially limit national security, and borrow from international lenders to finance health care. The intimate connection between health care spending and the nation's debt crisis is well understood by public finance experts. Alice Rivlin, first director of the Congressional Budget Office, former head of the Office of Management and Budget, and former vice chair of the Federal Reserve Board, concluded, “Long-run fiscal policy is health policy.”1 Minor tweaks to the current fragmented system will not lower costs or significantly improve quality of care. In short, US health care requires a major change in organization and delivery, but time is running out.

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