^{Prospectively,  ObamaCare Sounded Good, in Retrospect Not So Good}

^{In retrospect,}

^{Seven years ago,}

^{ObamaCare’s big idea  sounded simple.}

Cover everybody.

^{Regulate the doctors.}

^{Cut their fees.}

^{Put them on salary.}

^{Organize them.}

^{Herd them into organizations,}

^{Where they didn't  want to go.}

^{Make them provide better more accessible care
at lower costs.}

^{Guide, direct, and control}

^{all aspects of care,}

^{health plans, hospitals, and medical practices.}

^{Minimize  doctor  independence.}

^{Maximize  doctor dependence.}

^{Think big.}

^{Think oxymoronically.}

^{Increase coverage.}

^{Decrease costs.}

^{Cut Medicare by $575 billion}

^{Promise to save money}

^{Promise to reduce premiums}

^{By $2500 per family.}

^{Promise you can keep your doctor}

^{and your health plan.}

^{Think systematically.}

^{Think in terms of big systems.}

^{Think about what you know patients need.}

^{Develop systems for them.}

^{Launch big new programs in name of innovation,}

^{with impressive sounding acronyms,}

^{CMMI(Centers of Medicare and Medicaid Innovation),}

^{ACOs (Accountable Care Organizations),}

^{BPCI (Bundled Payments for Care Improvement -BPCI ),}

^{APMs  (Alternative Payment Models).}

^{MWV (Medicare Wellness Visits),}

^{MACRA (Medicare Access and CHIP Reauthorization Act).}

^{Promise more care at  lower costs.}

^{Think as a team.}

^{Stress  improvement.}

^{Involve everybody, cover everybody.}

^{Convince the public the old ways were bad,}

^{and unfair.}

^{Remind them where you’re going.}

^{Set goals.}

^{Give reasons when you miss your targets.}

^{Think about the big picture.}

^{Think about how the big problems.}

^{Organize to solve them in  big ways.}

^{Think about what kills people too soon.}

^{Prevent what kills them prematurely,}

^{through Medicare Wellness visits.}

^{Think how to minimize complications.}

^{Promise to save Medicare money.}

^{Give doctors the electronic tools,}

^{You think they will need at site of care,}

^{even if the tools  costs $29 billion.}

^{Give patients information they need -}

^{at home, at work, and at sites of care.}

^{Invest heavily in electronic health records.}

^{Say we’re all  in this together}

^{Broadcast your accomplishments.}

^{Rationalize  your shortfalls,}

^{Never admit your failures.}

^{Minimize the information gap}

^{between caregivers and patients,}

^{and sooner or latter,}

^{everybody  will recognize,}

^{where you’ve been}

^{and where you’re going,}

^{and what it all means.}

^{Your chief information officer, Philip Fasano}

^{will be quoted in}

^{“The Face of Future Health Care”}

^{(New York Times, March 20, 2013),}

^{as saying.}

^{“We have all the pieces,}

^{Anything a patient needs,}

^{You can  get in the four walls of our offices”}

^{The article will also quote,}

^{George Halvorson,  CEO of  Kaiser Permanente,}

^{He will sum it up simply,}

^{“All of this adds up to better care and cheaper care."}

^{The future prospects of health care}

^{sounded simple prospectively.}

^{But in retrospect,}

^{realities kept getting  in the way,}

^{costs rocketed  higher,}

^{doctors choose to see fewer Medicare and Medicaid patients,}

^{access became difficult,}

^{choices narrowed,}

^{insurers revolted,}

^{they exited exchange markets.}

^{raised  premiums,}

^{deductibles made care unaffordable.}

^{Unpopularity of your health  law grew.}

^{Millenials complained and did not join exchanges,
Older folk who joined were sicker.
and left exchanges after being treated.}

^{The middle class groused about  low wages and high health costs.}

^{Patients chose direct care without 3rd party coverage.}

^{ObamaCare  paved the way for concierge medicine.}

^{and became its best salesman.}

^{In retrospect,}

^{As poet Robert Burns said,}

^{“The best laid schemes o’ mice and men}

^{Gang aft a-gley.”}

^{Translated, this means:}

^{In retrospect, foresight is never 20/20:}

^{hindsight always is.}