Turning Back the Clock — Or Pushing the Envelope?

John A. Marcille

What goes around comes around.” Those of us not of vindictive temperament hope the adage applies to good things as well as bad. Perhaps that’s the reason physicians seem to warm to the idea of a health care system in which patients can purchase their own insurance with the help of “defined contributions” supplied by employers.

Nancy M. Dickey, M.D., president of the American Medical Association, was one of many experts who spoke to Senior Editor Frank Diamond for our cover story on the “individual option.” The AMA is pushing the plan, saying it restores freedom of choice to patients. Others quickly point out that it would put doctors back in the driver’s seat (understandably, the AMA doesn’t stress that), citing history in saying that that would be bad for health care: Fee-based medicine led to rising costs led to backlash led to managed care led to….

Would doctors, in fact, bond with patients as in the good old days? Would patients be inclined to favor doctors who overprescribe and overtest? How would you guarantee that employees actually spend defined contributions on health care and not on weekend getaways? How could individuals afford premiums that employers now buy at group rates? Where would all this leave HMOs?

Perhaps the most important question of all: Isn’t this all very premature? We’re still waiting to find out how medical savings accounts will fare.

Yet, how quickly things can change in health care. How quickly things can change, period. It wasn’t so long ago that the 800-pound gorilla stalking our dream of a brighter future, the budget deficit, seemed to be parked permanently in our living rooms. That was due, partly, to an ever-burgeoning defense budget needed to keep missiles trained at an “Evil Empire.”

Well, guess what? It’s 10 years later and patients are asking what plan you’re with, so they can join it. That’s not so far-fetched, is it?

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