...is paved with good intentions." - This common quote is often attributed to the Cistercian abbot Saint Bernard of Clairvaux (1090 – 1153), or at least so says phrases.org.
All right, old Saint Ben probably could not have foreseen just how lasting and applicable that quote could be. For example; moving forward eight hundred and fifty years or so we find ourselves in the late 1960's good old USA when people were deeply concerned about the rapidly rising cost of health care.
Somehow they were able to get the attention of doctors and other providers who promised "voluntary cost containment." That quickly turned out to be totally ineffective so Health Maintenance Organizations surfaced and were made legit by the HMO Act of 1973...signed by none other than Tricky Dick Nixon himself.
The whole premise behind HMO's was based on expert professionals who would use the purchasing power of large numbers of potential patients (enrollees they had signed for health insurance) to negotiate reduced rates from health care providers. Of course, the pro's would retain a certain portion of enrollee payments (premiums) for administrative costs and profits. HMO's caught on fast and, seeing potential for shit-tons of profit, large old indemnity companies like Aetna, Prudential and Blue Cross/Blue Shield bought in big time.
Moving forward again about 13 years to around 1987...I was just finishing a career with the Air Force and had spent half of it as a health care administrator. I was a proud product of a contained (military) health care model and deeply ingrained in a not-for-profit, common ground system that included no distinguishable greed or avarice. It was a great experience but I was ready to move on to new challenges. So, I was interviewing to work in a for-profit hospital system (Hospital Corporation of America), a non profit HMO system (Kaiser Permanente) and a for-profit HMO (Foundation Health then HealthNet now Centene).
I ended up signing with Foundation Health. I was intrigued by the notion of health care cost containment, believing that at some point Americans would demand it, maybe when they were paying say...25 cents of every dollar they earned.
Around that time, I attended a meeting of the American College of Health Care Executives and was in discussion with one of my old pals from grad school, Ron Terry. I asked him his general opinion of HMO's and his response; "I think they are a parasite on the health care system." It turned out Ron was absolutely correct in his assessment but at the time it seemed to be the only viable means to keep health care providers from jacking up costs to the moon. (Yes Vern, I was pretty naive and uninformed.)
Today, HMO administrative salaries drain billions of dollars from the common man's pockets and HMO's are loaded with spikes to impale consumers...spikes such as adverse selection, denial due to pre-existing conditions, over and under utilization, limits on allowable procedures, regular premium hikes that exceed rising provider costs and so on.
Here is what it seems to boil down to...if we let insurers drive the bus, they will take us where they want for whatever price they would like to charge. If we let providers to the driving, they will do the same. It's only human nature folks. So, we need a single-payer system, like Medicare, with full authority to negotiate prices, particularly with big pharmaceutical companies. This means administrative overhead at less than 5% (with no profit) as opposed to HMO overhead that ranges from 20-30% (with profit). It lets the passengers tell the bus drivers where they want to go and how much they are willing to pay to get there.
Would there be problems with such a system? Of course there will...so we will need a strong consumer watchdog entity but we already have a bunch of those so we would just need to change their mission. Also, all these countries are doing it (single payer that is, or as some would say, "National Health Insurance") and I am sure we can do it better than them if we really want to:
Austria, Belarus, Croatia, Czech Republic, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine, and the United Kingdom.
After all, we are master innovators right (?) and we can cherry pick their best practices!
