Investors may push for efficiency, either directly by pushing ACO managers to provide more cost-effective care, or indirectly, by passing on the purchase of EOC-ABSs if the originating ACO has a history of high costs relative to profits.
His point was that much of the explosive growth in the trading of complex financial products - CDOs, ABSs, CDS, EFTs and so on, until we were all alphabetty crazy - may have been (in his words) socially useless.