The behavior of health insurers is back in the news in a big way this week. As premiums have gone up and as health insurer profits have gone up even more, the reputation of health insurers as measured in public opinion polls has stayed just above that of the tobacco companies. Now one of the nation's giants, Wellpoint's Blue Cross unit, is accused of canceling the policies of people who got sick, even though they had followed all the rules--conduct more expected to be found in a John Grisham novel (The Rainmaker to be exact) than of a steward of its sick members.
Health insurers in many ways are our best hope. They alone have the data to understand what care is being delivered system-wide and they have the ability to promote practice-pattern improvements and disease management programs which might actually promote care quality. But just as the benefits of managed care were cast aside with the demonization of HMOs in the 1990s, a backlash against insurers might also end the possible good they can do. Employers might also start asking exactly what insurers are doing to justify those increasing profits and associated systematic reductions in their "medical loss ratios." Eventually, the wider question about what value health insurers really add might become a topic for debate. And we need to remember that health insurance companies as we know them--especially for-profit ones--are unknown in most other countries. - Matthew