Medicare Direct Contracting Scam Renamed ACO REACH

If you put lipstick on a pig or polish a turd, you still have a pig and a turd.

If you put lipstick on a pig or polish a turd, you still have a pig and a turd.


[Note:  Thais article is meant to be read in conjunction with Elizabeth Marshall's Cascadia Daily piece “There goes your Medicare: The trouble with DCEs” and my recent article, “The Blob” or Peace Health’s Latest Expansion Gambit”]

The National Retiree Legislative Network President, Bill Kadereit, has been quoted saying that the Direct Contracting Entities (DCEs) program could usher in a dangerous new stage of Medicare privatization: “Medicare Advantage plans have failed. Privatization has failed. The cost of Medicare is doubling every ten years because of the health care sector campaign contributions. We’re seeing the disassembly and destruction of our precious public health system. Every place where the profiteers have stepped in costs have gone up and health outcomes have gone down.”  

You know you have touched a nerve when there is criticism of a program, like PeaceHealth’s Direct Contracting Entities, and the federal response is to double-down and implement even more unscrupulous changes to the program. Then, as the second prong of the response, the local DCE grifters within PeaceHealth spring into defensive mode with an aggressive, preemptive letter writing campaign.

Dr. Scott Foster is the Chief Medical Executive of PeaceHealth’s new DCE, which is now open for business as Cascadia Community Care Alliance. Dr. Foster is also a master of the eye roll, which he seems to use to relay that “even I can't believe I am saying this shit.” (Watch this League of Women Voters video--preferably with a double gin and tonic or some other mind altering drug.) Most recently, Foster has written to the Cascadia Daily News in defense of the newest Center for Medicare and Medicaid Innovation (CMMI): the ACO Reach. This latest scheme and scion by PeaceHealth is one more attempt to get a bigger chunk of our Medicare dollars. So don't be surprised if you feel a hand in your pocket or purse, because someone is, indeed, about to “reach” for your Medicare.

You can read Foster's letter here, but the quote below will give you a preview of the flavor of the half-truths and dissembling contained therein: 

"Since Medicare doesn’t fully cover the cost of care and largely has an arm’s length relationship with beneficiaries and their service providers, other organizations may use DCEs in the way Ms. Marshall describes. As a nonprofit, however, PeaceHealth’s foremost obligation is to the patients and communities we have served for more than 130 years. Since we don’t make profits — instead re-investing in improved care and services to the community — our motivation in starting up a DCE was to improve patient outcomes, improve access to care, and reduce the cost of care for patients and for Medicare (including the taxpayers who fund it)."  

So Foster, et al., are the men and women in the white hats galloping in to rescue Medicare from itself, a program that was running perfectly well for decades but suddenly must be bolstered by private enterprise and people paid hundreds of thousands of dollars per year to make it even “better.” Currently, it costs about 1% of a Medicare dollar for the government to run the program. This new deal, ACO Reach, will scrape off as much as 40% from that same dollar and send the money to the coffers of those who already have so much money they don't know where to spend it. But you can be damn sure that you, as a Medicare patient, will never see those bucks again. I did not just fall off that turnip truck, so I can do kindergarten math, and so can you: one is smaller than 40. Even using “new math.”    

A better idea for PeaceHealth would be to start a for-profit plumbing or electrical business whose earnings would be donated to PeaceHealth; at least the money would be honestly made and real skilled workers employed in the process. Even better, they wouldn’t need to muck about in health care decisions that people want to make with their physicians. So, to paraphrase and give an updated twist to our former president, Ronald (Legend  in His Own Mind) Reagan’s immortal words, “We are from the private sector and we are here to help you.”

To learn more about this Rosemary's Baby of government pseudo-health care from an excellent and comprehensive The Lever article, read this piece “Seniors’ Medicare Benefits Are Being Privatized Without Consent”, a quote from which  appears  below. 

"CMMI was created under President Barack Obamas signature health care law, the Affordable Care Act (ACA), to pilot new payment models in Medicare and Medicaid without going through the formal rulemaking process that requires public comment. As a result, the new DCE program, which assigns seniors to a privatized model without their consent, has never been subject to any public scrutiny whatsoever."

ACO Reach seeks to replace these contracting entities (DCEs) already described above to extract money from the Medicare program and place it in the wallets of private sector poltroons, poseurs and mountebanks - not to mention the hedge funds, investment trusts, hospital conglomerates or any corporation that cannot make money any other way than through government approved, organized thievery worthy of a mob boss.  Also from The Lever article:

"The new program — which stands for Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model — allows hospital-led managed care organizations to access the new Medicare privatization scheme, too. ACO REACH similarly assigns patients with little informed consent to for-profit plans that benefit health care profiteers and creates incentives to deny care.

The DCE and ACO REACH programs are being spearheaded in part by CMMI head Liz Fowler, a former Obama administration official who helped write Obamas signature health care act as the chief health counsel to former U.S. Senate Finance Committee Chairman Max Baucus (D-Mont.). Earlier, she helped write the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, legislation that barred the government from negotiating lower prescription drug prices."

You can't go wrong with that model, especially if you don't give a whit about actual health care. Hence, the PeaceHealth webpage on its contracting entity, Cascadia Community Care Alliance, is a saccharine and smarmy presentation of a potentially lethal (to patients) and extractive program with respect to its Medicare for-profit LLC theft. Having had questions myself on this “care alliance,” I contacted Nate Vogt, listed as System Director DCE/CIN Operations, on several occasions via email. Nate, however, never bothered to answer. Were any sort of customer service part of Nate's goal, you might think that actually answering questions from the public would be part of his job and a high priority.  

As a friend wrote to me recently, 

“Though we live in [Representative] Pramila Jayapal’s [(D-WA)] state, our “Democratic” Congress members refuse to lift a finger to oppose DCEs -they won’t even sign Jayapal’s letter to HHS! [Written before ACO Reach was announced] They should be “primaried” for that and many, many other reasons. We are hard at work to locally pass Ranked Choice Voting so we can get rid of our useless “representatives” who refuse to protect their constituents’ interests.”

What you can do is to contact your representative or senator in Congress and tell them to get their butts in gear to pass legislation that will end this broad-daylight, health care robbery. You can also talk to your primary care physician to determine if the “contracting entity" at PeaceHealth has captured the Medicare patients in that doctor's practice. Call PeaceHealth and tell them to stay out of the privatization of Medicare. And write or call Nate Vogt at or 360-729-1681 and tell him it is not nice to ignore the public.  

If you protest, the jobs and the existence of this malignant appendage to PeaceHealth can be very short term.

About Dick Conoboy

Citizen Journalist and Editor • Member since Jan 26, 2008

Dick Conoboy is a recovering civilian federal worker and military officer who was offered and accepted an all-expense paid, one year trip to Vietnam in 1968. He is a former Army [...]

Comments by Readers

Abe Jacobson

Mar 25, 2022


Thanks for this excellent survey of the stealth privatization of Medicare.  I appreciate the hard work you have put into gumshoeing this matter, which has been intentionally kept out of public sight.



Dick Conoboy

Mar 26, 2022


There is a reason Vlad Dracul’s progeny are only active under the cover of the dark.


Lisa Dekkr

Apr 06, 2022

Pramila Jayapal, Chair of the House Progressive Caucus, in “official-speak”, said in a letter to HHS Secretary Becerra, signed by 52 members of Congress: “DCE’s pose a threat to patient care and outcomes due to the encroachment of profit-driven organizations in their care. “ 

PNHP, Physicians for National Health Program has created a website,, that shows why these programs are a real threat to what was supposed to be a “public good.”  Check it out. Hands Off Our Medicare !


Dick Conoboy

Apr 07, 2022


Thank you for a also alterting me in an email of the existence of   the grassroots, citizen organization called Puget Sound Advocates for Retirement Action (PSARA)  on whose agenda is fighting this privatization of Medicare.  I urge readers to visit their website to gather additional information on privatization and the organization’s work to combat it. 

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