When the current century started, one thing that struck me was how much it felt like the 20th century.

Another thing that struck me, when I looked at lists of the insurance companies that National Underwriter (a print publication that feeds news into LifeHealthPro.com) covered in 1901, the names on the list were mostly the same companies we were covering in 1901.

See also: 7 reasons National Underwriter’s new New York location blows my mind

A few companies merged out of existence, or dwindled into insignificance, and a few came to vigorous, chart-topping life, but, mostly, the big insurers went out, kept writing business, and survived panics, then: the Great Depression, World War II, Korea, stagflation, even (mostly) the rise of managed care.

Even the terrorist attack on the World Trade Center and various outbreaks of flu that looked as if “It Could Be the Next Pandemic!” barely registered. Occasionally, a carrier would mention something like that in a footnote, to entertain the securities analysts.

Now, low interest rates and the upheaval related to the Patient Protection and Affordable Care Act of 2010 (PPACA) seem to be about to change the Top 10 charts.

See also: Fitch: Big health deals may bring on small deals

On the one hand, if the upheaval knocks out deadwood and unnecessary costs, change may be the policyholder’s friend, and, in the long run the insurance industry’s friend. In the long run, the insurance industry will do best when the policyholders see that they are getting good risk-management value for a good price.

See also: On the Third Hand: Competition

On the other hand, it looks as if consolidation has eliminated so many jobs that it’s all but eliminated candor. People with a political ax to grind go around blaming X, Y or Z for poisoning kittens and strangling puppies, as they always have, but few level-headed insiders dare to say “boo” about any specific problems with federal laws, federal regulations, general business practices, their own companies’ executives, other companies’ executives, or any specific other thing that matters.

In theory, for example, organizers of the new nonprofit, member-owned CO-OPs spawned by PPACA should be flooding insurance trade publications with candid by-liners about the fascinating lessons they’ve learned over the past few years, but those by-liners seem scarce, if any exist at all. Because, you know, jobs. 

On the third hand, maybe the utter lack of candor is good for us. Maybe it gets us ready for a poorly run single-payer system. What we don’t talk about won’t hurt us. (Except, perhaps, when it does…)