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The history of managed health care is fraught with problems and potholes. We should not be proud of health care history in the USA - it is a disgrace. We pay more than any other country in the world and get less than two-thirds of the services received by most of the worlds population. And, the worst part of it seems that everybody says we have the best doctors, hospitals and nurses! So why aren't these people performing?

The answer to Americas health care problems can be found in one area - profit and loss. Managed care came about so that health care organizations could control costs and thereby maximize profits. By paying the service providers a percentage of their income from premiums, the insurance companies managed to pull the wool over many millions of eyes. They did not manage the claims against the insurance companies - they eliminated them!

If you are an insurance company and have $100 coming in each month and you only pay out $40, you can pocket the $60 for yourself. The service provider eventually recognized they were getting screwed and refused to accept anymore patients insured with XYZ Ins Co. The patient eventually realizes that his service provider is not as attentive as in the past and they become concerned about their health future. The insurance companies CEO awards themselves several million in salaries and perks.

The customer hot lines and service aspects of insurance becomes regulated by the availability of dollars to pay for a level of service. That is to say the insurance companies only allow for so much service for clients who are insured in the manner described above - more popularly known as Health Maintenance Organization (HMO). Routine claims start to be denied for bogus reasons and nothing seems to be able to be done because nobody thought the insurance companies would screw the clients this badly. Anything borderline that can possibly labeled as experimental medicine (IE: Heart, liver,lung transplants all went through this labeling process) and claims for services in these areas were denied until public pressure forces them to accept and pay.

The HMO organizations, through cost cutting, were able to change the number of days and hours a client can stay in a hospital and received intensive care of any kind. They finally relented when having a baby was reduced to hours of care, rather than the 3 days of traditional care. They did it when the press and clients raised such a stink the insurance companies could not avoid worsening image problems.

Now we come to an era when single payer health insurance appears to be winning a position of over arching popularity among politicians and clients. The insurance companies and their friends seem to be doing their level best through their political friends and advocacy organizations to stop this movement. Article after article hits the media and the Internet focusing on why this system won't work and why we need to avoid this form of insurance.

Over the next 6 months as the presidential election cycle works its way out we shall see how much can be done to kill the single payer concepts floating about. I suspect that a true single payer system will never be passed in this country. Somehow, the insurance companies will manage to modify or alter the concept so they can continue to rip our health car dollar to pieces.

Learn more about this author, Fred Tolleson.
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