Accountable healthcare: a national trend may have just landed in a hospital near you


In July 1965, President Lyndon B. Johnson signed Medicare into existence, and handed former President Harry Truman the first Medicare card. There was much celebration.

The next day, the struggle began to keep the program solvent.

It’s not much of an exaggeration, really. Medicare was less than a decade old when, in efforts to contain rapidly escalating costs, Health Maintenance Organizations and managed care were born (1973).

At its most basic, managed care is a model for keeping healthcare costs as low as possible without actually sacrificing human lives to save a buck.

If you are younger than a Boomer, you may ask what Medicare and managed care have to do with you. The answer is, “Plenty,” and not just because you contribute to Medicare with every earned paycheck. It’s also because private health insurance companies have adopted iterations of the same model: HMO, POS, PPO, EPO. The feds tinker with the model continually. One of the latest, called Accountable Care Organizations (ACOs), came out of the Affordable Care Act and they are really taking off now. And the impacts to actual patient care are real, and not always positive.

DeKalb’s city government frequently proclaims that it is responsible, transparent, accountable, and proud. None of these things is true. It makes sense to me to cast a skeptical eye upon any level of government using any of these descriptors, especially on our turf.

This is me saying that Northwestern Medicine’s proposed construction of a fitness mega-facility next to the Kishwaukee Family YMCA, and the $15 million in renovations being discussed at DeKalb County Rehab and Nursing center, are probably related to the formation and operations of ACOs.

We need to get to know them, stat.