There's just no practical way to do it. If a payer wanted to do capitation payments to a single isolated acute care hospital how would they even figure out what to pay and what incentive would the hospital have to take that deal? In order for something like an accountable care organisation (ACO) to work they have to control all aspects of patient care so that they have a chance to address problems early, long before the patient is admitted to the hospital.

I think this is similar to the idea of Health Justice that I've heard Tim Faust talk about. The reason the hospital will take the deal is simple, it's the only deal by law and the private insurance payers will be eliminated.

We don't live in a dictatorship and there's no way politically to force them to take that deal. Major changes won't be made to the healthcare system without at least rough consensus from the wealthiest and most powerful stakeholders, including major hospital chains. Even under single payer systems, hospitals are funded at least partially based on the actual amount of care delivered.

As you can see with the tax plan being rammed through, the minority of the wealthiest can ram through whatever they damn well please. We can do the same to them. We outnumber them.

Any yes, we can rationally allocate resources to ensure care is adequately delivered.