Accommodating oneself to an idea whose time has come is either like riding a wave or riding a tiger's back. A push for universal health care was defeated in Oregon in November thanks, in part, to opponents spending $5.8 million to defeat it.That was about four times as much as proponents spent.

Backers of universal coverage vowed that the idea wouldn't die, and they were right.

Before he decided not to enter the 2004 presidential race, former Vice President Al Gore had come out for universal coverage. Massachusetts Sen. John Kerry, who is considered a frontrunner for the Democratic nomination (though he hasn't formally announced his candidacy), also likes the idea.

Now, some health plan executives support the proposal, apparently believing that universal coverage not only doesn't mean the end of managed care, but could be what saves it. The trick is to divorce universal care from the notion that only a single payer — the government — can provide such services.

"If we don't do something in a darn hurry about the uninsured, the whole health care system in this country is going to collapse and the government will step in," says Chuck Butler, vice president of Blue Cross Blue Shield of Montana.

He wants state legislators to increase taxes on cigarettes to ensure "basic coverage" for all residents.

Bruce Bodaken, CEO of Blue Shield of California, wants that state to adopt a universal care system that would, according to the New York Times, provide "an essential benefits package, designed by independent medical professionals, that would guarantee preventive care, physician services, hospital care, and prescription drugs" through private or public health insurers.

William McGuire, MD, CEO of UnitedHealth Group, the nation's largest for-profit insurer, has sent letters to each member of Congress, asking them to OK a plan to provide "essential health care for all Americans."

Such lobbying makes business sense.

"It would dramatically increase the size of the market and spread the risk better," says Todd B. Richter, a health care analyst with Banc of America Securities, about Bodaken's comments.

Also, addressing the problem of the uninsured will help to shore up the health care system.

Caution. Politicians may want to go further with an idea that hasn't been associated much with the managed care industry. Executives should always keep in mind that stealing the thunder of a populist movement means standing close to the lightning.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.