In addition to many novels, French writer Alphonse Karr published a monthly journal of “stinging commentary.”
In that 1849 journal, Karr penned the phrase for which he is most remembered. Roughly translated and oft repeated, he wrote, “The more things change, the more they stay the same.”
Karr could have been referring to my first column on these pages nearly 16 years ago titled “Managed care: What’s being managed, and who cares?” The column focused on the general public distrust for the managed care process.
I quoted a Kaiser Family Foundation study showing that more than 60 percent of (survey) respondents were worried their plan “would be more concerned about saving money than about what is the best treatment if they are sick.” The public revolted. Many will remember the hue and cry about “insurance company accountants making decisions about your health care.”
Even the doctors were fed up. As I reported then, “A poll taken in New Jersey indicated that of the 1,000 people questioned, 89 percent believed that doctors needed to take the important health care decisions about families out of the hands of insurance companies. By a 61 percent to 19 percent margin, poll respondents agreed that HMOs were far too involved in medical decisions and patient care.” Consumer groups sought to enact “legally enforceable national standards.” Kaiser Permanente, HIP Health Insurance Plans and Group Health Cooperative of Puget Sound joined with Families USA and AARP to issue a consumer’s bill of rights.
I concluded that first column by writing, “These people may be attempting to manage care, but if they continue to play into the suspicions of the consumers they serve, the backlash could look a lot more like nationalized health care than they care to consider. They would be wise to consider that when you invite the tiger to lunch, the tiger always eats last.”
Fast forward to present day America. We now have what might best be described as a hybridized national health care system (or at the least, an attempt at such an arrangement). Instead of worrying about insurance company accountants setting rules and making decisions, some are beginning to worry about federal bureaucrats interceding between patients and doctors. Americans are once again wary, and the physician community is, predictably, even less happy than it was 16 years ago.
One of my doctors recently said that he and his partner were thinking of converting to a cash-based, non-insurance practice model and asked, “How long until we have single payer?” I told him that if I were in his position, I might be more concerned about when the government will begin to require doctors to see any patient with an exchange-qualified plan. Unbelievably, that notion had not occurred to him.
You can’t keep your plan
For many Americans, there are other more personal and immediate concerns. Even as PPACA was being debated, proponents knew it would disrupt doctor patient relationships and cause many happily insured Americans to lose their existing coverage.
So what was their strategy? They assured everyone that if you liked your plan you could keep your plan. The president (29 times by one count) said, “If you like your plan, you can keep your plan, period. If you like your doctor, you can keep your doctor, period.”
Senate Majority Leader Harry Reid used it as a selling point. Senate Democratic Whip Dick Durbin went even further when he said, “Many people say: ‘I like my health insurance right now. I don’t want to change. I don’t want to go into Medicare or Medicaid. I like what I have. Would you please leave people alone?’”
Answering his own question, he said, “The answer is yes. In fact, we guarantee it. We are going to put in any legislation considered by the House and Senate the protection that you, as an individual, keep the health insurance you have if that is what you want.” Every proponent had a similar story to tell.
Yet, even then, they knew millions of individual policyholders would lose their current plans, a projection that has been realized. It will get worse. Those same calculations also project that as many as 69 percent of small-business plans — representing nearly 49 million insured Americans — will be canceled due to non-conformity as well. And those chickens have not yet come home to roost.
Today, millions of Americans have found they will not, in fact, be able to keep their current plan — or perhaps their current physician and/or preferred local hospital — and that many will need to pay significantly more for new plans deemed not to be “substandard” by government minders.
I would wager that no reader of this magazine ever believed that assurance, nor did any of you believe government-prescribed plan designs with richer benefits but priced with fewer rating mechanisms would be less expensive. It strains credulity to think our elected representatives in Washington believed anything other than that as well.
President Obama has responded by making yet another amendment to the “settled law” (as proponents like to call it when confronting PPACA adversaries) to permit carriers to continue the non-conforming plans for another year. The discussion of whether a president can amend a law passed by Congress seems to be lost in the scrum — at least for the present. There will undoubtedly be challenges.
There are several ongoing Congressional attempts to “fix” the cancellations in the individual market. H.R. 3550, Representative Fred Upton’s “Keep Your Health Plan Act,” passed the House by a vote of 261-157 (with 17 not voting). There are other initiatives in the Senate as well. Ron Johnson’s S. 1617 and Mary Landrieu’s S. 1642 are also in play.
According to the Heritage Foundation, while these bills are “well intentioned,” they “will not solve the problem.” They note that the Upton bill is temporary, and that “many onerous Obamacare mandates that disrupt coverage for the 49 percent of Americans with employer-provided coverage” have not been addressed.
All these machinations belie the question asked in the headline of that first column so many years ago. We now know what, and who, is being managed. We also know the answer to “and who cares?” As the steamroller that is PPACA lumbers on, the heavy handed managed care initiatives of yore that generated so much indignation and concern will seem insignificant compared to what is to come. It is the same bull. Only the matador is different.
End note: The reason I was looking at my old columns is the announcement by Bill Coffin, our group editorial director, that the venerable Life Insurance Selling magazine will merge with National Underwriter Life & Health to “create a single title with the largest audience, the best editorial and the deepest footprint of any publication in the life & health publishing space.”
I am happy to say that I will continue to expound on health and employee benefits in our new home. The newly expanded NU Life & Health will retain a strong focus on our readers and core audience — agents and brokers, more than 60,000 strong. All of us look forward to delivering the information and commentary you need to keep delivering value to the consumers you serve each and every day.
To all of you, longtime readers and newly found friends of the column, please accept my best wishes for a healthy, happy and prosperous New Year. To paraphrase my friend Byrd Baggett, we need to look at life through the windshield and not through the rearview mirror. See you in the new, expanded NU Life & Health.