Tag Archives: Rahm Emanuel

A good weekend in Chicago? Less than a dozen shot


CBS Chicago: A 17-year-old boy was killed and 10 other people were wounded — including two people on the Kennedy and Dan Ryan expressways — in shootings across the city since Friday night.

The teenage boy was fatally shot in the head Saturday afternoon in the South Side Bronzeville neighborhood. He was shot shortly before 3 p.m. in the 3900 block of South Prairie, police said. The boy was taken to Stroger Hospital, where he was pronounced dead at 3:44 p.m., according to the Cook County medical examiner’s office. His name was not released Saturday evening pending notification of his family.

Police said the shooting is gang-related, and that the boy was a documented gang member.

The most recent nonfatal shooting occurred early Sunday on the Dan Ryan Expressway on the South Side. A man, whose age was not immediately known, was in a vehicle travelling southbound on Interstate 90/94 when he was shot near the 79th Street exit, Illinois State Police said. That person was taken to Christ Medical Center, but further information was not available.

Just two hours earlier, at 1 a.m., a male was shot on the Kennedy Expressway on the West Side. The male — whose age was not immediately known — was in a red Ford Mustang that was heading northbound on I-90 when he was shot near the Fullerton exit ramp, police said. That person was taken to Illinois Masonic Medical Center, police said, but his condition was not available.

About 2:10 a.m., a 30-year-old man was shot in the West Garfield Park neighborhood. The man was shot in the leg and ankle in the 4100 block of West Adams, police said. He was taken to Mount Sinai Hospital where his condition had stabilized, police said.

On Saturday night, a 17-year-old boy and a man, 20, were shot in the Humboldt Park neighborhood on the West Side. The boy and man were both shot in the leg about 7:45 p.m. in the 1700 block of North Kimball, police said. They were taken to Presence Saints Mary and Elizabeth Medical Center, where both of their conditions had stabilized.

Two hours earlier, a man was shot and seriously wounded in the South Side Calumet Heights neighborhood. The 18-year-old man was shot “multiple” times at 5:45 p.m. in the leg in the 9200 block of South Clyde, police said. He was taken in serious condition to Christ Medical Center in Oak Lawn.

Earlier Saturday afternoon, a man delivering fried chicken in the Washington Park neighborhood was shot during an attempted robbery on the South Side. The delivery man, 39, got out of his car to deliver chicken to a customer about 12:40 p.m. near South Prairie and East 57th, when a male approached, pulled out a gun and announced a robbery, police said. The would-be robber started shooting, striking the delivery man in the abdomen, police said. He then ran off without stealing anything.

The delivery man then went back to his place of employment, from where he was taken to University of Chicago Medical Center, police said. He was transferred to Mount Sinai Hospital, where his condition had stabilized.

About 1:30 a.m. Saturday, two people were hurt in a shooting in the Auburn Gresham neighborhood on the South Side. A 23-year-old woman and a 42-year-old man were inside an establishment in the 1700 block of West 87th Street when someone outside opened fire, police said. A bullet grazed the woman’s leg and she refused medical treatment at the scene. The man showed up at Christ Medical Center with a graze wound to the head, and he was listed in good condition, police said.

The weekend’s first shooting happened about 11:10 p.m. Friday in the West Side Austin neighborhood. A 27-year-old man was standing outside in the 1700 block of North Mason when an unknown male walked up and opened fire, striking him in the arm and leg, police said. He was listed in good condition at West Suburban Hospital.

Additionally, police shot and critically wounded a man after he allegedly struck an officer with a car Saturday night on the West Side. Undercover officers driving an unmarked squad car stopped the suspect — a man thought to be in his 20s — about 10:15 p.m. in the 2300 block of West Lake as part of a narcotics investigation, police and Fraternal Order of Police spokesman Pat Camden said.

After the stop, two officers exited their car, but the suspect accelerated and struck the police vehicle, according to a statement from Chicago Police. As a result, one officer was knocked to the ground, police said. The suspect then tried to flee — and almost ran over the fallen officer in the process — but was shot multiple times by police, according to police and Camden.

The male officer was taken to Northwestern Memorial Hospital, where his condition had stabilized, officials said. Police said the officer’s injuries were not life-threatening. The man shot by police was taken to Stroger Hospital in critical condition with multiple gunshot wounds to his upper body, officials said.

The Independent Police Review Authority is investigating the shooting, spokesman Larry Merritt said.


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Quiz time: How many were shot in Chicago over the weekend?


NBC Chicago: At least 22 people have been shot and several others stabbed in violent attacks across Chicago this weekend. Police said five people were fatally shot and two people were stabbed to death this weekend.

The weekend’s first homicide took place around 11:30 p.m. Friday when police found a man stabbed to death inside a home in the 5800 block of North Mobile Avenue. Officers were conducting a well-being check after neighbors reported a disturbance leading to a fight outside the home. Police arrived and found a 36-year-old man in the kitchen with multiple stab wounds. He was pronounced dead at the scene, officials said.

Around the same time, a 20-year-old man was fatally stabbed during a robbery attempt in the West Rogers Park neighborhood roughly 6.5 miles away. The man was standing near a park in the 6200 block of North Hoyne Avenue when a group of men walked up and demanded his cell phone. When the man refused, he was stabbed. The victim was taken to Swedish Covenant Hospital where he was pronounced dead, police said.

Around 3 a.m. Saturday police said a 64-year-old man was killed during an attempted robbery outside a store in the 1500 block of South Lawndale Avenue. The man was approached by two men who shot him while attempting to rob him. He was taken to Mount Sinai Hospital in critical condition and was later pronounced dead, according to Chicago Police News Affairs Officer Janel Sedevic.

Just after 4 a.m. Saturday,  a 19-year-old man was shot in the chest in the West Town neighborhood. The teen may have been a passenger in a vehicle at the time of the shooting, which took place in the 500 block of North Bishop, police said. The teen was taken to Stroger Hospital in critical condition, but the Cook County Medical Examiner’s office confirmed the teen died Sunday morning.

Two people were shot to death within an hour Saturday night.

Just before 9 p.m., three people were shot in the 7200 block of South Damen Avenue. A 19-year-old man was shot in the head and was initially transported to John H. Stroger Jr. Hospital of Cook County in serious condition but was later pronounced dead, according to Chicago Police News Affairs Officer Jose Estrada.

An 18-year-old woman was shot in the leg and a 22-year-old man was shot in the arm. Both were taken to Advocate Christ Medical Center in stable condition.

Police said the three were standing at the corner of 73rd and Damen when a black sedan pulled up and a man got out and opened fire. Area South Detectives are investigating.

A little less than one hour later, officers were patrolling the city’s Bronzeville neighborhood when they reported hearing gunshots. The officers searched the area and found a 24-year-old man on the sidewalk in the 4500 block of South Evans Avenue. The man was unresponsive at the scene with multiple gunshot wounds to his body. He was taken to Northwestern Memorial Hospital where he was pronounced dead.

Just before 4 a.m. Sunday, a security guard shot a drunken man who attacked him after being asked to leave a restaurant in the 4500 block of North Kedzie Avenue. Police said the security guard asked a 47-year-old man to leave the facility and the intoxicated man returned a short time later armed with a knife. The man confronted the guard and attacked him, police said. The guard then shot the man. The man was taken to Illinois Masonic Medical Center and was later pronounced dead.

At least 11 people were wounded in shootings since Friday. Three others were hurt in a stabbing in the city’s Loop early Sunday morning.


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Quiz time: How many were shot in Chicago over Labor Day Weekend?

Chicago Sun Times: Three men were killed and at least 33 other people have been wounded in shootings across the city over Labor Day weekend.

The most recent fatal shooting happened Sunday night in Rogers Park. Two men, both 29, were shot about 8:45 p.m. in the 7400 block of North Ridge, police said. One was shot in the abdomen and the leg, police said. He was taken to Saint Francis Hospital, where he later died, according to police and the Cook County Medical Examiner’s office. His name was not released Monday morning. The other man was shot in the right leg and taken to Illinois Masonic Medical Center, where his condition had stabilized, police said.

Another man died Saturday morning, about five hours after he was shot and critically wounded on the Far South Side. Darius Sept, 34, was shot in the abdomen about 12:30 a.m. in the 10900 block of South Racine, authorities said. Sept, of the 1100 block of West 107th, was pronounced dead at Christ Medical Center at 5:41 a.m., a spokesman for the medical examiner’s office said. Police said he was uncooperative with investigators at the time of the shooting.

About 10:45 p.m. Friday, a 36-year-old man was found lying on the sidewalk in the 5400 block of South Damen with gunshot wounds to his head and thigh, police said. He was taken to Stroger Hospital, where he was later pronounced dead. The medical examiner’s office confirmed the death, but the man’s identity was not released Monday morning.

The most recent non-fatal shooting happened early Monday in South Lawndale, where a man and a teenager were both critically wounded. The 17-year-old boy and 22-year-old man were sitting on a porch in the 4300 block of West 25th Place when two people got out of a vehicle nearby and started shooting, police said. The teen was shot in the arm, back and chest, and the man was shot in the head, police said They were both taken in critical condition to Mount Sinai Hospital.

About two hours earlier, a girl was wounded in a West Englewood neighborhood drive-by shooting. The 15-year-old was talking with friends near an alley about 1 a.m. in the 6900 block of South Justine when a dark-colored four-door Pontiac pulled up and someone inside opened fire, police said. She was shot in the leg as she ran away. Her condition stabilized at Comer Children’s Hospital, police said. The Pontiac fled westbound on 69th Street.

About 9:20 p.m. Sunday, a man and a woman were wounded in a possible domestic-related shooting in the South Deering neighborhood. The man, 51, and the woman, 27, were both shot near 95th and Oglesby , police said. The shooting is believed to have stemmed from a domestic argument, but detectives were still trying to determine who fired the weapon. The man was in serious condition with multiple gunshot wounds at Christ Medical Center, police said. The woman was also at Christ with a gunshot wound to her arm. Her condition had stabilized, police said.

At least 27 other people have been wounded in shootings across the city since 7 p.m. Friday.



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Gun control in Chicago: 3 dead among 21 wounded in afternoon, overnight shootings


Chicago Tribune: Three people were killed and at least 18 wounded in shootings across Chicago between Friday afternoon and early Saturday morning, including two officers wounded in a Far South Side shootout.

The shootout was one of two officer-involved shootings overnight. The violence stretched from Rogers Park to as far south as 93rd Street and into the Austin neighborhood on the western edge of the city.

Two officers, a man in a car who started shooting at them and a woman that was in that car were wounded in an exchange of gunfire about 11:30 p.m. Friday in the 9300 block of South Wallace Street in the Brainerd neighborhood. The man shot by police was in surgery overnight but all three of the others are expected to survive.

About 3 a.m. Saturday in the 3600 block of West Shakespeare Avenue in the Logan Square neighborhood, police shot at a man they saw shoot someone else. The police officers missed and the man fled on foot. Information about the person he shot wasn’t immediately available from police.

Two shootings happened in the Bronzeville neighborhood about a block apart during the 13-hour stretch of shootings. Two people were shot in the 4600 block of South Ellis Avenue about 3:10 a.m. Saturday. A 20-year-old woman was shot in the face and a 21-year-old man suffered “multiple” gunshot wounds. They were taken to Northwestern Memorial Hospital, police said; their conditions weren’t available.

About 6 p.m. Friday in the 4600 block of South Drexel Boulevard, a 30-year-old man was shot in the right leg and taken to Northwestern Memorial Hospital in stable condition, police said. Details about the shooting weren’t immediately available. It’s not clear if this shooting is related to the one on Ellis.

Four other shootings happened in the Austin neighborhood, three within a few blocks of each other.

The first happened about 4:15 p.m. Friday in the 4900 block of West Augusta Avenue, where a 27-year-old man was shot in the upper left thigh. He was taken to West Suburban Medical Center but details about that weren’t immediately available.

Two others were shot in the 500 block of North Leclaire Avenue about 10:15 p.m. A 27-year-old woman was grazed in the shoulder and a 15-year-old boy was grazed in the back. The boy refused to be treated at the scene. He had been walking on the street when someone fired from inside a car. The woman was taken to West Suburban Medical Center and was stopped in a car when the shooting started and she was wounded, police said.

Twenty minutes later in the 1000 block of North Lamon Avenue, someone shot a 16-year-old boy in the back. He was taken to John H. Stroger, Jr. Hospital of Cook County. He was walking with friends when someone on foot opened fire, police said. The 16-year-old  ran and was found by police near the intersection of Leclaire Avenue and Thomas Street, about two blocks away.

Near the corner of Cicero Avenue and Quincy Street in the Austin neighborhood about 3:30 a.m. Saturday morning, a 20-year-old man was grazed in the foot. He was standing outside when someone got out of a blue car and started shooting, wounding the man. He was taken to Loretto Hospital in good condition, police said. That happened about 3:30 a.m.

Four people were shot, one fatally, in the Washington Park neighborhood overnight.

An 18-year-old man was shot in the leg and a 19-year-old man was shot in the arm about 11:55 p.m. Friday in the 6100 block of South Wabash Avenue. The two were approached by three young men, one of whom opened fire, hitting the pair. They were both taken to Stroger hospital in stable condition, police said.

About 90 minutes later Saturday morning and five blocks north, in the 5600 block of South Wabash, someone shot two young men in an alley. A black car sped away and police gave chase but lost sight of the car on the Dan Ryan Expressway, though it was spotted again near North Avenue and Lake Shore Drive. Police responded to the block for a shots fired call and found the two men on the ground, unresponsive, and a large crowd nearby. An 18-year-old man died at the scene and a 20-year-old man was taken in critical condition to Stroger hospital, police said. The man who died was identified by the Cook County medical examiner’s office as Brian Weekly, of the 1400 block of West 79th Street.

At 10:42 p.m. in the Washington Heights neighborhood, a 22-year-old man was shot as he walked on the sidewalk in the 10100 block of South Aberdeen Street, said Chicago Police Department News Affairs Officer Michael Sullivan. The man told police he heard shots and felt pain in his ankle. He was taken to Little Company of Mary Hospital in Evergreen Park, where his condition had stabilized.

Just minutes later in the 100 block of N. Keeler Avenue in the West Garfield Park neighborhood about 10:45 p.m. Friday, someone shot a 22-year-old woman to death. She was shot in the torso and was pronounced dead at Mount Sinai Hospital, where police said she had been taken in critical condition. A spokesman for the Cook County medical examiner’s office identified her as Carnesha Fort, 22. She lived where she was shot, police said.

Earlier in the Morgan Park neighborhood, a 23-year-old man was shot in the leg in the 11200 block of South Marshfield Avenue about 2 p.m., Cooper said. The man was in good condition at an area hospital, but the exact hospital and the circumstances of the shooting were not immediately available.

An 18-year-old man and a 20-year-old man were shot in the 1900 block of West Howard Avenue in the Rogers Park neighborhood about 1:45 p.m. Friday. Alante Vallejo was pronounced dead about a half hour later at Presence St. Francis Hospital in Evanston and the 20-year-old was treated for a foot wound. Vallejo lived in the 200 block of Ridge Avenue in Evanston, according to the Cook County medical examiner’s office.

Chicago’s violence is out of control. Yet Mayor Emanuel’s solution is to require gun dealers to videotape the sales “to discourage traffickers and buyers who use false identification”. I’m sure that will solve the city’s crime problem…



‘Rahm will look good': Emails show how CNN producers worked with Chicago mayor’s office to portray him as a ‘star’ of documentary series

Incoming White House Chief of Staff Rahm Emanuel gestures prior to inauguration ceremony of Barack Obama as President of the United States in Washington

DailyMail: Chicago is no stranger to corruption so perhaps it’s unsurprising that recently released emails show how CNN worked with city officials to portray Mayor Rahm Emanuel in a positive light for “unscripted” documentary series “Chicagoland”.

The Chicago Tribune obtained more than 700 emails that reveal how the CNN production team filming the eight-hour series worked with the mayor’s office to develop storylines – getting their input on details like camera angles and the working of press releases for the show.

The emails are made all the more inflammatory by the fact that Emanuel is currently running for re-election in 2015, and the documentary appears to be reinforcing his campaign.

“Make no mistake” This is Rahm Emanuel’s story, his re-election campaign vehicle. This is the boss of Chicago selling his heroic narrative to American voters,” Tribune columnist John Cass wrote following the report.

The pandering starts as early as October 2013, when director Marc Benjamin writes Emanuel’s director of communications, asking for more access to the mayor in the series which was shot the following spring.

“I know I am needy but we want more of Rahm in the series, I know I sound like a [broken] record, but in the Feb. 14 broadcast, Rahm will look good making “his” points,” Benjamin writes.

By February, CNN seems to have struck a deal with Emanuel when executive producer Marc Levin sends off an email to a press aide, saying he is “thrilled that City Hall and the Mayor have agreed to assist our production team, help steer us to strong stories and participate directly in the CNN series.”

When they started filming the series, Emanuel was planning on closing 50 public schools, the largest school closure in the city’s history.

The CNN producers hoped to take advantage of that moment to “highlight the Mayor’s leadership” going into detail on exactly what kind of shots they needed – such as the mayor talking on his phone in the car.

“I know we still have time to round out the mayor’s story and present him as the star he really is,” Levin writes in another email.


The mayor’s press office was so involved in the production that they even edited news releases prepared by CNN to announce the show, as shown in one email.

Besides the shady staging of Emanuel in the documentary, there are some other noted conflicts of interests.

Producers Levin and Benjamin are both represented by the William Morris talent agency, which is run by Ari Emanuel – the mayor’s brother.

When reached by the Tribune for comment, Levin said that everything Emanuel does is “stage-managed”.

“This is the way he operates, so I’m not going to dispute that,” Levin said. “I would be the first to acknowledge that you don’t get into Chicago…and get access without having to do a certain dance.”

CNN reinforced that message in a statement to Mediaite Friday. “The mayor’s office was never granted editorial control over the content or the press communications for Chicagoland, and no agency was ever granted authority to offer the mayor’s office editorial approval for the content or the promotional materials for the series.”

Chicagoland premiered March 6 on CNN after being showcased at the Sundance Film Festival in January. It was produced by Robert Redford.



Hillary Clinton has INDUCED mental disorder to prevent her from running for POTUS


There are rumors that, contrary to popular belief, Hillary “what difference does it make” Clinton won’t be running for president in 2016 because of her ill health. Recall that right before she stepped down as the POS’s secretary of state, she had that strange health incident wherein she supposedly fainted, fell, struck her head and sustained a concussion.

But Rev./Dr. James David Manning says that Hillary’s disorder is “mental.” More intriguing still, Manning claims that his source says her mental disorder has been “induced,” the purpose of which is to ensure that Obama will continue as POTUS beyond his second term and in violation of the Constitution’s 22nd Amendment.

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Obamacare architect says private health insurance companies will die by 2020

Ezekiel Emanuel is a medical doctor, the brother of Chicago mayor and former Obama White House chief of staff Rahm Emanuel, and an architect of the unAffordable Care Act, better and more appropriately known as Obamacare.

E. Emanuel is also a proponent of “universal health care,” which really should more correctly be called nationalized, government-paid, or taxpayer-paid health care. Another euphemism for nationalized health care is “single payer.”

A prerequisite for such a socialist health care system to be put in place is, of course, the elimination of private insurance companies, which critics have long suspected to be one of Obamacare’s real goals.

In an op/ed for The New Republic, March 2, 2014, Ezekiel Emanuel confirms our suspicion. The op/ed is excerpted from his 2014 book, Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.

H/t The Blaze and FOTM’s Miss May.


Ezekiel Emanuel

Dr. Ezekiel Emanuel

Insurance Companies as We Know Are About to Die And here’s what’s going to replace them

By Ezekiel J. Emanuel

Americans hate health insurance companies. They are easy targets for everyone to beat up on. When premiums go up, we blame insurance companies; we do not blame the underlying hospitals or physicians who charge high prices that drive up insurance costs. When people with cancer, heart attacks, or other diseases are denied insurance, we blame insurance companies; we do not blame the underlying voluntary insurance market that necessitates underwriting. When our wish for a new high-priced drug is denied, we blame insurance companies; we do not blame drug companies that set the price at over $100,000. Politicians can always elicit an applause by attacking the health insurance companies, reinforcing this bad-guy image of insurance companies.

This is not to say that insurance companies are angels, but they are also not the devil incarnate. A lot of what people consider to be their bad behavior is the inevitable result of the way the health care system is structured and how it incentivizes and forces certain behaviors.

The good news is you won’t have insurance companies to kick around much longer. The system is changing. As a result, insurance companies as they are now will be going away. Indeed, they are already evolving. For the next few years insurance companies will both continue to provide services to employers and, increasingly, compete against each other in the health insurance exchanges. In that role they will put together networks of physicians and hospitals and other services and set a premium. But because of health care reform, new actors will force insurance companies to evolve or become extinct. The accountable care organizations (ACOs) (which I discuss in Chapter 8 of my new book) and hospital systems will begin competing directly in the exchanges and for exclusive contracts with employers. These new organizations are delivery systems with networks of physicians and hospitals that provide comprehensive care. This health delivery structure is in its infancy. Today there are hundreds of these organizations being created and gaining experience within government-sponsored programs or getting contracts from private insurers. They are developing and testing ways to coordinate, standardize, and provide care more efficiently and at consistently higher quality standards. Over the next decade many of these ACOs and hospital systems will succeed at integrating all the components of care and provide efficient, coordinated care. They will have the physician and hospital networks. They will have standardized, guideline-driven care plans for most major conditions and procedures to increase efficiency. They will have figured out how to harness their electronic medical records to better identify patients who will become sick and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs.

The key skill these ACOs and hospital systems lack—the skill insurance companies specialize in—is the actuarial capacity to predict and manage financial risk. But over the next decade this is something they will develop—or purchase. After all, actuarial science is not rocket science, even if it involves a lot of mathematical equations. And with that skill, ACOs and hospital systems will become integrated delivery systems like Kaiser or Group Health of Puget Sound. Then they will cut out the insurance company middle man—and keep the insurance company profits for themselves. Therefore, increasingly these ACOs and hospital systems will transform themselves into integrated delivery systems, entering insurance exchanges and negotiating with employers, in direct competition with insurance companies.

This trend is already beginning. A recent article noted,

More health systems are seeking to contract directly with employers with deals to bundle the price for certain services or serve as exclusive contractor for all healthcare services for a company’s employees, as in a recent agreement between Intel and Presbyterian Healthcare Services in New Mexico. The direct deals have emerged as hospitals and doctors face mounting pressure to keep healthcare spending in check.

As they gain more experience in managing groups of patients, such contracts between health systems and employers—cutting out insurance companies—will become more common. At that time the health systems will make the jump to offering coverage in the exchanges. In turn, the health insurance companies will have three possible responses. First, they can refuse to change, in which case they will eventually go out of business. Second, they can shift their business to focus on offering services they have expertise in, particularly analytics, actuarial modeling, risk management, and other management services. An example that foreshadows this evolutionary path is United Healthcare’s Optum subsidiary, which sells management services to ACOs, hospitals, physicians, and health plans. As these customers need more help with analytics, risk management, and disease management, Optum will grow.

The third evolutionary path is that health insurance companies may transform themselves into integrated delivery systems. ACOs begin with the delivery system and will need to add the actuarial capacities to become integrated delivery systems. Insurance companies, however, start at the other end: they begin with the actuarial skills and need to add the actual providers of care. The easiest way for them to accomplish this is to buy or enter into exclusive agreements with efficient hospital systems, ACOs, or physician groups. This is just beginning to occur. A foreshadow of this future was the 2011 purchase by Wellpoint, one of the five largest for-profit insurers, of CareMore for $800 million. CareMore is a Medicare Advantage health plan headquartered in southern California with facilities in Arizona and Nevada. It delivers very high-quality care at costs that are about 20% below competitors. Presumably, in anticipation of developing efficient delivery systems, Wellpoint wanted the “secret sauce” on how to deliver high-quality, low-cost care to a sick population. Similarly, hedging its bets, Optum owns physician practices with about 5,000 primary care physicians and is on its way to developing integrated delivery systems in 75 different health care markets.

In January 2012 Jeffrey Liebman and I predicted in The New York Times the end of health insurance companies by 2020. We might have been a bit optimistic—or provocative. But it is certain they will end. Insurance companies will largely cease to be the middle man—taking premiums, paying providers, saying no to consumers, and making a profit—that we blame. Whether we will come to love them is another matter. That depends on how well they actually care for patients. Some people may be concerned about the prospect of having to choose among large integrated delivery systems with selective physician and hospital networks. The worried well might wonder what happens if they contract a serious illness, such as cancer or some rare disease, will they be restricted only to the physicians in the delivery system? We should note that many people pick Kaiser or Group Health and get all of their care from those integrated systems, and they don’t seem to worry that they are not getting the highest-quality care. The real issue is not whether there is a selective network of physicians and hospitals; the real issue is whether the network is of high quality. Having the assurance of a high-quality network is the key. These integrated-delivery systems will begin competing with their objectively validated, high-quality networks.

More importantly, health systems have learned from the managed-care backlash; just saying “no” really aggravates people, especially well-off, powerful people. Although it may be cheaper in the short run, it can be expensive, especially in terms of reputation, in the longer term. There are better ways to approach this.

I suspect these integrated delivery systems of the future will adopt two strategies. For rare but serious conditions they will identify recognized centers of excellence—the absolute best places in the country— and contract special arrangements for the referral and treatment of their patients. These centers of excellence may have slightly higher sticker prices, but forging these special arrangements will be worth it for integrated delivery systems because then they will be able to boast negotiated rates, better outcomes, and fewer complications. Second, richer and, thus, more expensive benefit packages, such as platinum plans in the exchanges, would cover second opinions. In addition, there will be a market for supplemental insurance that covers second opinions for serious conditions. The well-heeled and worried will be a prime target for such plans.

So be prepared to kiss your insurance company good-bye forever.