One person's thoughts and a bit of history on healthcare change through insurers, employers and hospitals...all who can be considered bad guys at times...due to current practices, etc.  and his thoughts on reform...BD

Why the shift? There are a lot of reasons. But a big one, surely, is the growing outrage at corporations -- starting with America's insurance companies -- that seem to make more money while the people they serve get less health care.

The commercial insurers had hit upon a bonanza, passing the Blue Cross plans in overall enrollment by the 1950s. One by one, they moved away from community rating and guaranteed issue, adopting the same underwriting practices as the private sector -- and, in many cases, converting outright to for-profit status.

Employers, too, used to act differently. One reason employer-sponsored insurance worked for as many Americans as it did, for as long as it did, was that until the 1970s the large manufacturers dominating the American economy basically agreed on the desirability of providing their employees with coverage.  

The behavior of hospitals hasn't changed as much as that of insurers and employers. Truth be told, hospitals were never that excited about treating the uninsured. But it was during the 1980s and 1990s, when the insurance companies began putting unprecedented pressure on them to reduce costs, that many changed their pricing structure -- in ways that transferred higher bills onto the uninsured -- and outsourced their collection work to specialized legal firms.

The real solution, then, is wholesale reform -- so that insurers can't game the system by picking out the healthiest people, so that employers can't gain an edge on their competitors by stiffing them on coverage, and so that hospitals can't offer lower prices simply by shirking the uninsured.  So as the debate over health care heats up, go ahead and bash the bad guys. They probably deserve it. Just remember that the bashing alone won't change the rules of the game.

System failure - The Boston Globe


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