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Why Scalia Should Sing About Obamacare With Springsteen

By       Message Michael Millenson     Permalink
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There I was, going one-by-one through a list of doctor and hospital groups that had volunteered to be one of the "accountable care organizations" authorized by health care reform, when I inexplicably found myself breaking into song. I know: it's a really strange way to react to ACOs, but bear with me.

You remember, "This Land is Your Land," don't you? Written by Woody Guthrie in 1940, it caught the folk music wave of the 1950s, and has been sung ever since by performers ranging from Pete Seeger to Johnny Cash. Odds are you at least know the first verse:

This land is your land, this land is my land

From California to the New York Island

From the Redwood Forest to the Gulf Stream waters

This land was made for you and me.

ACOs are not obviously song-worthy, although they are significant. One of the Affordable Care Act's signature initiatives, they initially drew bipartisan support as far back as...well, 2010. In April, the government announced that thousands of doctors serving more than 1.1 million Medicare beneficiaries had voluntarily joined ACOs, giving up fee-for-service reimbursement for some patients in exchange for a paycheck that's based on measurable standards related to high-quality, cost-effective care. They've made the switch because it's the right thing to do and because they're getting ready for a day when Medicare's fee-for-service money dries up.

But I was not singing about financial savings.   What inspired me was geography. At a time when political hyperventilators portray Obamacare as an evil government plot, the diversity of locations where ACOs have voluntarily formed shows that people outside Washington know that health reform is about making care better.   So get out your guitar and follow along with me:

From California, the ACOs include Sharp HealthCare, situated in San Diego (where the local GOP boasts that "the Republican Party is proud to be the majority party"), and HealthCare Partners, a Southern California mega-medical group sprawled over a political landscape ranging from ultra-liberal to ultra-conservative.

To the New York Island, which has my favorite ACO, the Chinese Community Accountable Care Organization, serving the elderly population of New York City's Chinatown. It's a locale that undoubtedly includes illegal as well as legal immigrants. There's also a Bronx ACO (not technically on the New York "island"), but alas, no ACO for Little Italy, the Lower East Side or Spanish Harlem. I also searched in vain for, say, a Palm Beach ACO for affluent retirees who've gone from a golf handicap to a real handicap.

From the Redwood Forest. Really, who besides gnomes, sprites and a few tree huggers lives in a redwood forest? Fortunately for the nature-loving elderly -- perhaps aging ex-hippies worried about their artificial hips? -- there's the Heritage California ACO, whose eight-county area includes the redwood forests of San Luis Obispo.

To the Gulf Stream Waters. This one was easy: the Accountable Care Coalition of the Mississippi Gulf Coast. No word on whether its doctors are conveniently located near the slot machines of a local casino.

So there you go: This land was made for you and me.

The moral of this story is clear: Americans who love this great country should sing out their support for Obamacare and ACOs. If Woody Guthrie's left-wing past concerns some would-be crooners (I'm looking at you, Antonin Scalia -- we know you sang in a chorus before joining the Supreme Court), they can comfort themselves that "This land is your land" has been embraced by the Mormon Tabernacle Choir singing along with the United States Air Force band. You don't get more patriotic than that.

Speaking of patriotism, look at this version of "This Land is Your Land" with a background track by Bruce Springsteen underscoring a speech by a guy who'd just won the 2008 Democratic presidential primary in Iowa.

No red states, no blue states -- just the United States of America. Woody Guthrie and the Air Force band. Hey, Supremes, sing it out for Obamacare: "This land was made for you and me."


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Full-time job as consultant and quality-of-care "evangelical," working for improved quality, safety and patient-centeredness in health care. Writer, author, speaker and skewerer of sacred cows. A native of Washington, DC, I am a political junkie who (more...)

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Why Scalia Should Sing About Obamacare With Springsteen