Controlling the Narrative: The Myth of Managed Care

As the 1980’s dawned upon the American public, which was coming out of extended period of economic turmoil, the Insurance Industry happened upon and old idea, Health Maintenance Organizations (HMOs), as the panacea for the continually rising cost of receiving health care services in the United States. Specifically, they began to push HMOs.That was quickly followed by a bevy of “products” that were similar in nature to HMOs distinguished generally only by the name of the product and the choices of “networks” a member, formerly known as a patient, could choose. The insurance industry assured the healthcare consuming public, employers and health care providers that this was the solution to control costs and ensuring that each member saw the right provider, in the right setting, and received only those services necessary to treat the condition presented. The caveat of course, was that the Insurance industry didn’t not grant the health care provider the right to decide what was “necessary” to treat the “member” but rather the Insurance company would use “unique tools” to ensure the waste and abuse in the system was eliminated and members would receive only the care they needed to remain healthy.Astoundingly, the American public bought into the idea that the Insurance industry knew how to treat their medical condition better than the provider who was diagnosing and treating them. 

They even paid some lip service to preventive care back in the 80’s and started including reimbursement for weight loss programs, (only the one they choose for you) or gym memberships to ensure members understood that wellness was the key to reducing health care costs and living a long, happy, healthy life, except it all turned out to not be true. One only need to look at their latest Explanation of Benefits or Premium payment to judge whether the Insurance industry delivered on the promise of Managed Care. Thus, the question must be asked: How did the American public get duped into paying roughly 13% of GDP for Health care in the 1980’s to almost 19% of GDP forty (40) years later?This article seeks to focus on only one variable of many that has led to this crippling increase in the cost of receiving health care in America, who is responsible for the myth of Managed of Care and its total failure to deliver on the promise of better care at a reduced cost. It was once said of problem solving in a group setting, that he or she that controls the narrative to define a problem, by extension controls the narrative to define the solution to that problem and the insurance industry most assuredly controls the narrative.