The bureauwonks blew it this time: Proposed regulations intended to save money by encouraging greater coordination of care amongst health providers have instead been rejected by the organizations that first inspired the idea.

ObamaCare's backers have insisted over and over again that the law helps control health spending through "delivery system reform"—by reorganizing, in other words, how medicine is practiced and paid for. And one of the law's most promising reforms, super-wonks like Medicare director Donald Berwick argued, was the creation of so-called "accountable care organizations" (ACOs), which encourage medical providers to coordinate their efforts in smart networks that many hoped would lead to cheaper, more efficient care. As evidence, they pointed to a few model provider groups like the Mayo Clinic, the Cleveland Clinic, and the Geisinger Health System in Pennsylvania. 

At the end of March, the Obama administration's Department of Health and Human Services released its first draft of the proposed ACO rules: 400-plus pages of regulatory legalese designed to tell doctors, medical administrators, and other health providers exactly how they ought to be coordinating their care and practices in order to appease the the administration's health bureaucrats. So will the new regulations usher in an era of smarter, more coordinated care like we've seen in those model providers networks? Not likely: A number of those care organizations took a look at the rules the Obama administration is proposing to set up and politely said something to the effect of, "No thanks." Mayo, for example, told Congressional Quarterly that there would have to be "substantial revisions" in order for the clinic to think about participating. The Cleveland Clinic has indicated that the proposed rules would put significant barriers in the way of their current (model!) care practices. And a representative from Geisinger said that the organization has "a large number of concerns" with the proposed regs: "A lot of the detail-level work is problematic. It seems to be very prescriptive and restrictive with a fair amount of administrative and regulatory oversight."

It's not the model that's wrong: In an age of complex medicine, coordinated health care may end up being better health care, and possibly even cheaper. The problem isn't with doctors and other proviers coordinating; it's with the federal government telling them how to do it. 

Lots more on ObamaCare's ACOs and why they aren't likely to work here