Since enactment of the Patient Protection and Affordable Care Act (PPACA) there has been considerable enthusiasm and hype over the provisions establishing accountable care organizations (ACOs). The purpose of today’s message is to look past the hype to see precisely what PPACA says about ACOs.

If the Republicans regain control of the House of Representatives in the election next week, as some experts predict, Rep. Paul Ryan will likely become Chairman of the Committee on the Budget. This will coincide with the release of the report from the Commission on Deficit Reduction – a report that many fear will recommend changes that would make significant cuts in the Medicare program. Clearly, Medicare is under threat.

Many have commented on the fact that the Patient Protection and Affordable Care Act (PPACA) did little to address one of the most important drivers of the reform process – our unique problem of the outrageous costs of health care. We spend far more per capita on health care than any other nation. This article by Alec MacGillis is singled out as recommended reading on this topic, as he is one of the most credible and well-informed journalists who closely observed the reform process.

The disputed math of the incentives for employers to either continue offering their employees health plans or to drop the plans in favor of employees purchasing their own plans in the exchanges is an important question because it determines whether employers will continue to contribute to the premiums or if the taxpayers will assume that burden through subsidies for the exchange plans. What is not so obvious is that, in the background, there are two much more important policy considerations.

Although I am taking a break this week and won’t provide a comment here, an excellent commentary on the Bodenheimer and West article has been posted by Joshua Freeman, Professor and Chair of the Department of Family Medicine for the University of Kansas School of Medicine. He states, “Grand Junction, Colorado may not have all the answers to our health care system, any more than Canada or Britain or Switzerland do. But it is doing a lot of things right, it is saving money, and it is improving the health of the community, and that’s a lot more than most areas in the US are doing.”

As part of the current fervor over implementing reform, considerable attention has been directed to controlling spending and improving quality by changing reimbursement methods from those based on volume and complexity of services to models based on measurements of clinical practices and health care outcomes.

When Congress wrote the Patient Protection and Affordable Care Act (PPACA), they did not want to disturb the very large sector of health insurance coverage that seemed to be working well – the employer-sponsored health plans. It was decided that high-quality plans, such as that of the employees of the University of California at Santa Cruz, should be protected so that the plans would always be there when the employees needed them, that is if they wouldn’t mind choosing between paying much higher premiums or losing their established physicians.

The majority of progressives predict that a single payer system is inevitable because the nation will no longer tolerate the increasing costs of health care. On the other side, many conservatives and libertarians predict that a single payer system may be inevitable because health plans will no longer be affordable in a regulated insurance market. Senator Tom Coburn and Professor Paul Feldstein represent the latter view.

This study covered 80 percent of the retail dispensing activity within the United States. It included patients for whom our health care system is working, at least theoretically. These individuals gained access to a physician, received one or more prescriptions, and then attempted to have the prescription filled by a retail pharmacy.

Can a health care system in a transitional society such as Bangladesh provide lessons for a modern industrialized nation like the United States? Well, yes. See how many lessons you can find here.