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?’”