Once upon a time (not so long ago actually), the healthcare landscape in Uncle Sam’s backyard looked quite different than it does today. Managed care – a two-for-one medley starring both health insurance coverage and healthcare services – took baby steps in the early 20th century. In this post, we’ll take you on a roller-coaster ride through the vibrant saga of managed care in America and argue that it may be the perfect occasion for a radical makeover – in the name of the greater good, of course!

American Managed Care: A Kaleidoscope of Colors

The Prologue

Our story begins in the early 20th century when insurance aficionados started extending a friendly hand towards medical treatments. Riding this early wave, Texas’ Baylor Hospital came up with a prepayment plan for schoolteachers and called it “Blue Cross”. In 1939, a motley crew of white-coat crusaders founded the first Health Maintenance Organization (HMO), the Ross-Loos Clinic, in the city of angels, Los Angeles. The idea was simple: offer all-you-can-treat medical services to their members within the boundaries of a fixed fee.

Managed Care’s Meteoric Rise

With the arrival of Medicare and Medicaid in the swinging 60s and 70s, the US dance floor got crowded and the government decided it was time to cut some costs. Et voilà – the Health Maintenance Organization Act of 1973 was born, providing federal incentives to create new managed care associations, thus marking the golden age of HMOs.

As the clock kept ticking, employers nudged their workforce into managed care plans like HMOs, Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. Their charm lay in greater flexibility, if you could live with the higher costs, that is.

However, by the late 1990s, managed care had turned from darling to demon in the public eye, as the system faced a barrage of criticism and demands for reform.

Riding the Roller-Coaster: Backlash and Turbulence

Flash forward to the late 1990s and early 2000s – folks were not exactly smitten with managed care anymore. Reports of denied services and physician frustration became the unpleasant tunes everyone hummed, while the floodgates opened to a deluge of litigation and negative media coverage. Managed care companies gained the unflattering image of cold-hearted organizations, more interested in shareholder profits than customer health.

Exit Managed Care, Enter…?

Alright, so now that we’ve successfully disentangled (more or less) the twisted tale of managed care in America, let’s take a gander at why it could be time to, well… manage care differently.

Love on the Rocks? Doctor-Patient Relationships in Jeopardy

Stranger danger! Third parties like insurance providers have caught a free ride into the hallowed dynamic between doctors and patients, leading to an unwelcome loss of autonomy for our white-coat warriors.

Quantity Crusher: Dwindling Quality of Care

The altar of cost reduction has seen its share of sacrifices, with denied care or approval of lackluster treatments emerging as unwelcome trends. Onerous bureaucracy adds insult to injury by stressing out healthcare providers, leading to distracted patient care.

Mystifying, Complex, Inaccessible Care

The epic quest for healthcare has become more labyrinthine with managed care, leading patients down a long, winding road of tiered networks and ever-changing deductibles. Limited access to healthcare providers within narrow insurance networks makes for even more disparities in the quality of care.

The Future of Healthcare: Brighter, Better, Bolder

If not now, when? It’s time to revamp our approach to healthcare and explore a model that values equity, accessibility, and patient-centered care. By prioritizing patient and healthcare provider needs as well as restoring autonomy, we can eliminate excessive bureaucracy. Embracing preventative care and venturing into innovative healthcare avenues, like telehealth, can contribute to a renewed healthcare phoenix rising from the ashes.

In summary, managed care’s American odyssey has seen moments of dazzling brilliance, but also sobering missteps. As we stand at a crossroads in healthcare, now is the pivotal moment for radical reform, redefining healthcare and ultimately leading to the well-being of one and all – and, indeed, the human race at large.

Authors Note: Telehealth, telemedicine, teledoctors and teledentistry (a real thing) is a huge scam by insurance companies to split you apart from your doctor which will lead to worse outcomes and they know this

Author was a insurance professional for almost a decade