This contrasts with current examples of such financing arrangements. Where physicians earn a preset salary for example, in Kaiser Permanente plans or in the British National Health Service patients frequently complain about rationed or delayed care. When physicians are paid on a fee-for-service basis, for every service or procedure they provide as they are under the insurance company model then care is oversupplied. In these systems, costs escalate quickly. <\/p>\n
Unfortunately, the leaders of the American Medical Association saw early health care models union welfare funds, prepaid physician groups as a threat. A.M.A. members sat on state licensing boards, so they could revoke the licenses of physicians who joined these alternative plans. A.M.A. officials likewise saw to it that recalcitrant physicians had their hospital admitting privileges rescinded. <\/p>\n
The A.M.A. was also busy working to prevent government intervention in the medical field. Persistent federal efforts to reform health care began during the 1930s. After World War II, President Harry Truman proposed a universal health care system, and archival evidence suggests that policy makers hoped to build the program around prepaid physician groups. <\/p>\n
A.M.A. officials decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model. <\/p>\n
In this system, insurance companies would pay physicians using fee-for-service compensation. Insurers would pay for services even though they lacked the ability to control their supply. Moreover, the A.M.A. forbade insurers from supervising physician work and from financing multispecialty practices, which they feared might develop into medical corporations. <\/p>\n
With the insurance company model, the A.M.A. could fight off Trumans plan for universal care and, over the next decade, oppose more moderate reforms offered during the Eisenhower years. <\/p>\n
Through each legislative battle, physicians and their new allies, insurers, argued that federal health care funding was unnecessary because they were expanding insurance coverage. Indeed, because of the perceived threat of reform, insurers weathered rapidly rising medical costs and unfavorable financial conditions to expand coverage from about a quarter of the population in 1945 to about 80 percent in 1965. <\/p>\n
But private interests failed to cover a sufficient number of the elderly. Consequently, Congress stepped in to create Medicare in 1965. The private health care sector had far more capacity to manage a large, complex program than did the government, so Medicare was designed around the insurance company model. Insurers, moreover, were tasked with helping administer the program, acting as intermediaries between the government and service providers. <\/p>\n
With Medicare, the demand for health services increased and medical costs became a national crisis. To constrain rising prices, insurers gradually introduced cost containment procedures and incrementally claimed supervisory authority over doctors. Soon they were reviewing their medical work, standardizing treatment blueprints tied to reimbursements and shaping the practice of medicine. <\/p>\n
Its easy to see the challenge of real reform: To actually bring down costs, legislators must roll back regulations to allow market innovation outside the insurance company model. <\/p>\n
In some places, doctors are already trying their hand at practices similar to prepaid physician groups, as in concierge medicine experiments like the Atlas MD plan, a physician cooperative in Wichita, Kan. These plans must be able to skirt state insurance regulations and other laws, such as those prohibiting physicians from owning their own diagnostic facilities. <\/p>\n
Both Democrats and Republicans could learn from this lost history of health care innovation. <\/p>\n
Christy Ford Chapin is an associate professor of history at the University of Maryland, Baltimore County, a visiting scholar at Johns Hopkins University and the author of Ensuring Americas Health: The Public Creation of the Corporate Health Care System. <\/p>\n
Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.<\/p>\n
A version of this op-ed appears in print on June 19, 2017, on Page A19 of the New York edition with the headline: How Health Care Went Wrong. <\/p>\n
<\/p>\n
Go here to see the original: <\/p>\n
How Did Health Care Get to Be Such a Mess? - New York Times<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" This contrasts with current examples of such financing arrangements. Continue reading