An elegy for today's health plans


"Had you rather Cæsar were living, and die all slaves, than that Cæsar were dead, to live all free men? As Cæsar loved me, I weep for him; as he was fortunate, I rejoice at it; as he was valiant, I honour him; but, as he was ambitious, I slew him." -- Act III, Scene II, Julius Caesar

Friends, Romans, healthcare system, lend me your ears. I come to bury health plans, not to praise them.

If you read the pivotal scene cited above, in which Brutus explains why he slew the beloved Julius Caesar, he explains that while the man may have had many fine qualities, he simply couldn't be allowed to live--since his lust for power was far too great. And that, my friends, is where things may stand with the commercial health industry as it exists today.

Much wailing and gnashing of teeth has gone on as to whether the so-called "public option" would cripple health plans by competing on terms they couldn't beat. To me, that discussion misses the point. The question is whether health plans deserve to be crippled or protected.

In the past, health plans have argued that employers would drive them out of business by negotiating as a team, that providers would be the end of them by demanding that they pay for appropriate and necessary treatment, that quality organizations would kill them by demanding a level of consistency and accountability that would be too expensive and difficult to deliver, and so on.

The bottom line is, their mission has failed. Managed care as a concept has failed, at least the way it was most optimistically defined at its inception. The idea that you can do more with less, as it currently works anyway, has degenerated into a mad scramble for power and money which regularly harms and sometimes kills patients.

The truth is, the core role of a "managed care" company can only be, in our current system, to deny care. That's the only role any insurance company can play. You're never going to be able to transform insurance companies into organizations which exist to pay FOR care; that's not underwriting, that's suicide.

So what's the reborn model? I don't know--but something's gotta give, and under the current crop of health reforms, it seems pretty likely it will. As for me, I'm not expecting to see the health plans murdered on the ides of March, but don't rule it out. -- Anne