I had almost forgotten the HMO Act that started the whole concept of 'managed care.' I just picked this up from the blog of a new commenter at my own little blog, The Impolitic. Andrew of Prospect Park Project has done some digging into the Nixon tapes.
Perhaps the best introduction to the Kaiser HMO and Kaiser Permanente Medical Care Plan is the summary by Mr. Edgar Kaiser that the less Kaiser does for patients the more money it makes. To get the full context one can go to the University of Virginia and review the presentation Mr. Edgar Kaiser (then Kaiser CEO) made to President Nixon through Mr. Erlichman — the less we do the more we earn. This convinced President Nixon to go forward with the HMO Act of 1973 with Kaiser as the template.
Andrew has a transcript at the link. It strikes me as I write this that even Nixon wasn't so crass or brazen a criminal to destroy the records of his tenure. That was the biggest lesson that the neo-cons learned from the period. Destroy the evidence. We'll never see the Bush White House tapes because they deleted them all. But I digress.
The corporatization of our health care delivery process can at least partly be traced back to this Act. HMOs drove out the family doctor and delivered the corporate behemoth that controls our health care today. Profit trumps best practices and we're all paying the price with a depersonalized system, based on numbers rather than need, that delivers diminished services.
This is why I don't understand the hysterical opposition to a national health insurance plan. It's not like private insurance is so great. The choice ultimately is between an essentially neutral bureaucracy over a plan that would include everyone and is accountable to the people for its performance or a private bureaucracy driven by profit that excludes millions of Americans and is accountable to no one. The choice seems obvious to me.