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The Gekkonian Gambit: Portrait of a modern HMO A New First Premise While the collapse of the Clintons’ reform plan in 1994 caused a sudden deflation of expectations, the severe fiscal crisis in health care remained. In fact, awareness of that crisis had been significantly heightened by the Clintons’ campaign to reform health care, and nobody (except, of course, some of the doctors) entertained the delusion that we could simply go back to business as usual. But as it turned out, a savior awaited. That savior was, naturally, that same insurance industry that had first built up then scuttled national health care reform. Only now the insurance companies had reformulated themselves into HMOs, had decked themselves out in Gekkonian raiment, and had fully assimilated the language of managed care. And here is what they said: “Citizens! We all – employers, patients, physicians, hospitals, manufacturers and insurers – have just dodged a bullet. Thanks to us, the frightening socialist reforms of the Clintons have been soundly defeated. “But where does this leave us? We stand now between Scylla and Charybdis, between the specter of nationalized health care on one hand, and the continued profligacy of traditional fee-for-service medicine on the other. And we cannot countenance either. “But here,” the Gekkonians continued, “is a third way. A painless way, based on the sound principles of open markets and free enterprise. Let health care become a business like any other business, and the market forces will find ways not only to cut costs but also to improve quality, etc., etc., and with no government intervention.” The offer, in other words, was to turn health care over to the marketplace, and let the efficiencies of the marketplace solve our problems. Because we’re Americans and we know the benefits of capitalism, and because the other choices we faced looked even worse, we all said: go for it. |
The result has been, over the past few years, perhaps the most rapid change our health care system has ever seen. While most of the changes have been real, palpable and material, the biggest transformation of all has been a philosophical one.
For all their faults, the Clintonians have always held to the age-old notion that the basic underlying purpose of health care is to maximize the public good. Indeed, they believe, this fact is what gives government the ultimate authority to regulate health care. Only the government can guarantee that the special interests will act in a manner appropriate to public benefit. (The flaw in this argument, for those of us who are suspicious of Clintonians, is that regulatory bureaucracies often wind up behaving as the biggest, meanest special interest of all.)
What the Gekkonians have given us is a brand new first premise. The primary purpose of health care, they say, is not to increase public benefit. How could it be, when health care is merely a business like any other business? What we should be striving for is to build a well-run business. Since well-run businesses are beneficial to the community, in the end we can expect plenty of benefits to go around. But the fact remains that health care is a business. And the primary purpose of business is to make money.
Next - Portrait of a Modern HMO - The story begins
Surviving the Health Care System is adapted with permission from YourDoctorintheFamily.com
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