After that, the experts and army of bureaucrats previous efforts had created decided that what we really needed was managed care in the form of Health Maintenance Organization (HMOs) and Preferred Provider Organizations (PPOs). In the decade from the mid-1980s to the mid-1990s, this new panacea resulted in a stampede as the penetration of PPOs and HMOs went from 7 percent of the private benefits market in 1984 to 82 percent in 1997. The entire market was thoroughly transformed in a mere 13 years.

That is, until the “managed care backlash” set in. People hated managed care so much that when the movie “As Good as it Gets” came out in 1997, audiences cheered when one of the characters said “Fucking HMO! Bastard pieces of shit!”

But the experts were undeterred. They loved managed care, so when the opportunity came along, they renamed HMOs “Accountable Care Organizations (ACOs)” and stuck them in Obamacare.

Curiously, the idea of ACOs was completely undefined. They were a very modest part of the law, taking up just four pages of the 2,700-page law (Section 3022), and applying only to Medicare. The requirements could not be more vague. The law simply calls for groups of providers to get together and save money, under the direction of the secretary of the U.S. Department of Health and Human Services—period. What they do and how they do it is left up to the secretary. To the extent anyone had a model in mind, he would suggest Mayo Clinic or the Cleveland Clinic, but nothing in the legislation suggests those as models.