
Contents
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Regulating for Creative Destruction Regulating for Creative Destruction
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Industry Turned Government Turned Industry Industry Turned Government Turned Industry
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The Compliance Department The Compliance Department
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Forging Compliant Dispositions: Demonstrating the Willingness to Comply Forging Compliant Dispositions: Demonstrating the Willingness to Comply
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The Social Life of Audits The Social Life of Audits
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The Self-Regulating Corporation The Self-Regulating Corporation
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Regulating through Audit Regulating through Audit
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Replaceable Replaceable
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Derailing the Train Derailing the Train
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2 Regulating a Runaway Train: Everyone Is Replaceable
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Published:August 2014
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Abstract
This chapter discusses the everyday nature of health regulation through audit, performance management, and corrective action in Puerto Rico. It sheds light on the unstable side of private enterprise by retelling the stories of former employees of Acme—one of the leading Medicare managed care corporations in the nation. The corporation is known for its “runaway train” principle when handling employees, a metaphor that explains the volatility created by the rapid growth of the Medicare Advantage market brought by privatization. Acme told employees not to expect stability and security and that everyone is replaceable. The image of the runaway train captures the momentum and sheer force of Acme's growth and constant transformation. The chapter uses Acme's principle to explain how the MMA had a major impact on the entire health care system in Puerto Rico by creating a lucrative market in Medicare plans.
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