That the relationship between managed care payors and their members and providers has become toxic is unsurprising to anyone engaged in health care, whether it be its recipients, providers or administrators. Managed care was set up to be adversarial from day one and payors have reveled in their "bad boy of health care" image ever since.
Six times in the past century -- during World War I, during the Depression, during the Truman and Johnson administrations, in the Senate in the 70s, and during the Clinton administration -- efforts have been made to introduce some kind of universal health insurance, only to be rejected. Each time, Americans have instead opted for a system of increasing complexity and dysfunction.
On any given day, 45 million Americans are uninsured and without access to affordable, necessary health care services; another 16 million are under-insured. According to the National Coalition on Health Care, employer health insurance premiums increased 7.7 percent -- two times the rate of inflation -- in 2006. Since 2000, employment-based health insurance premiums have increased 87 percent, compared to cumulative inflation of 18 percent and cumulative wage growth of 20 percent during the same period. Publicly traded managed care company CEOs are receiving multiple millions of dollars in cash incentives, bonuses, and stock options.
Conservative writer Ramesh Ponnuru points to technological developments and an aging population as exacerbating the trend of rising health care costs. To contain costs, employers partnered with HMOs to impose limits on patients and doctors. "There," Ponnuru states, "in a nutshell, is almost everything we dislike about modern American health care. It can be very good, but it is more expensive than it is worth; more bureaucratic, too."
Managed care payors wouldn't have it any other way.■