Accountable Care Systems – why import something so bad?

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Graph comparing different nations healthcare costs and efficiency

Sustainability and Trasformation Plans (STP) are being drawn up in secret by bodies that lack any legal status with no public consultation and from that process we are now seeing the emergence of Accountable Care Systems and Organisations (ACS/O).  These too lack any public engagement, transparency or legal status.

So far US-style Accountable Care Systems are planned in just eight regions but we have good reason to fear that the intention is to roll out this system across the whole of England eventually.

We have good reason to fear the impact that ACS will have on the healthcare system that is available to us.  This post will aim to explain why.

Image by Jonathantellerelsberg (view licence details)

Normally we tend to import the things we need.  So why now have we imported the accountable care model that is used for the expensive and ineffecient healthcare system of the States?

Origninally designed in America to limit the massive burden of healthcare costs on the nation at a time when General Motors was spending more on providing health insurance for its employeees than it was on developing new cars.  President Nixon brought out the Health Maintenance Organisation Act 1973 which was supposed to control costs, promising savings of 20%.  But, they cost 15% of the total cost of care to deliver, in short they were a spectacular flop.

The advent of Obamacare resulted in HMOs being redesigned to emerge as Accountable Care Systems.  Aimed at controlling the total cost of providing healthcare for any region and hence limiting the risk of offering insurance for anyone unable to pay for healthcare. Despite these limits imposed on the cost of delivering healthcare in the States the Americans will spend 20% of their GDP on healthcare by 2020 and 25% of their GDP by 2025.

The ACSs proposed for England are simply a means of imposing cutbacks in the availability and provision of health services to meet the specified and inadequate budget.  They are emerging from the secretive processes and bodies behind STPs and are not replacing but being superimposed above a costly and wasteful market system established in the HSCA 2012.

Campaigners fear that the emergence of ACOs may be a significant leap towards the eventual complete privatisation of healthcare in the UK.

In the States ACOs have an annual turnover of $180bn in their own right and made profits of $13.5bn in 2014.  The industry is the biggest investor in lobbying in the States.  Chief Exec of NHS England Simon Steven’s former employer, United Health, is the largest supplier of ACOs in America.

By opening up the English healthcare system to private providers we have already incurred costs through an out-of-court settlement to Richard Branson when Virgin Healthcare sued the NHS for not granting the running of one NHS service to his business.

Once Britain leaves the EU, if we are not in the single market our government will seek trade agreements with other countries.

A trade agreement with the States could result in American ACOs sueing our NHS if they were refused the right to run ACOs in our country.  I am sure I am not alone in suspecting that trade agreements may be on Trump’s mind when he makes his visit to the UK.  I am also sure that trade agreements were on Theresa May’s mind when she rushed over to visit Trump in the States soon after his inauguration.

If a future government ends any trade agreements with other countries the right or that country’s corporations to sue our government for limiting their ability to make profit in our country would extend for another 20 years.

The Accountable Care model will alomost certainly reduce the amount of healthcare services we have available to us. It may also present a tempting opportunity for private corporations to profit from our healthcare system.

There are just eight regions in England where the an ACS is being considered.  Currently the regulation that covers our NHS would be a barrier to this happening.

With an utter contempt for our country’s democracy our Government intends to lay down new regulations via secondary legislation to allow this to happen, with no automatic debate or vote in parliament.

The Labour Party have called an Early Day Motion (EDM) to seek a debate and vote, please ask your MP to sign this EDM from Jeremy Corbyn and Jon Ashworth.

There is also a judicial review to stop Jeremy Hunt and NHS England from introducing new commercial, non NHS bodies as Accountable Care Organisations  to run health and social services without proper public consultation and full parliamentary scrutiny.  These bodies would be governed by company and contract law and could be given ‘full resonsibility’ for NHS and adult social services. Find out more or donate to the crowdjustice campaign.  This is the legal battle that Stephen Hawking has now joined.

The prospect of Donald Trump’s visit to the UK is offensive to many people for far more reasons than I could hope to express here.  But if having somebody who incites hatred is not enough for you to get angry, and you are not worried  about having chlorine chickens on sale at your local supermarkets then the prospect of UK-US trade deals damaging our healthcare may get you angry.

Trade deals can be negotiated without Donald Trump visiting the UK but there is a large protest against Donald Trump’s visit being planned.  This protest will send a strong message to Theresa May that the public reject all he stands for including the American healthcare giants moves to make inroads into our healthcare system.  Join the fight against his visit and find out more about why this visit is provoking such outrage in the UK


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