What’s that line about insanity again?

I was amused by an article in the WSJ yesterday. I even loved the name. “Medical Time Warp“:

Under pressure to squeeze out costs, some of the U.S.’s biggest health insurers are quietly erecting more hurdles for patients seeking medical care.

The companies are in many cases reaching back to the 1990s and boosting the use of techniques that antagonized patients and doctors alike.

Today’s approaches are tweaked, but may feel familiar to many: Insurers are rolling out plans with more restricted choices of doctors and hospitals, and weighing new requirements for referrals before patients can see specialists.

UnitedHealth Group Inc., Cigna Corp. and others are increasingly requiring doctors to get prior authorization before patients can get certain care such as spinal surgeries.

Earlier versions of these practices were closely identified with the managed-care era of the 90s.

Shocked! Shocked, I am!

Seriously, what did people think insurers were going to do to cut costs? For all the talk of “innovation”, how many awesome new inventions have been created by insurance companies lately? How many new drugs? How many new procedures? None? So why do we think that all of a sudden insurers were going to have a new and awesome way to attack the cost problem?

Insurance companies can use the tools available to them. Setting roadblocks up makes it harder to get care and reduces utilization. Restricting patients to networks limits choice and allows for better contracts for insurers. Sure, these things piss off patients and providers, but they do work to reduce spending.

Even the new “progressive”  and “conservative” lists of methods to reduce spending in the health care system are really just collections of standard ideas. We’ve heard them before. I’m not saying they won’t work or that they’re not worthwhile; it’s just that they’re not new.

The problem isn’t that we don’t know what to do. It’s that we don’t like the tradeoffs involved in any choices. We don’t like giving up anything – ever. So we keep casting about for the perfect solution to the problem. You know, the one where no one is ever denied any treatment, where no one is ever told they can’t see a certain doctor, where no one ever waits at all for elective care, where no one makes any less money, and where no government is involved at all. Oh – and it massively reduces spending and fixes the deficit.

Let me know when you find it.



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