Is Software to Blame, Again?

by Anthony Robbins, MD, MPA

President Obama's health reform has been derailed in a collision with health insurance software, but this is hardly a unique experience. In 1995, I was invited to Prague to try to help the Czech Republic reconcile two co-existing public health practice cultures–the hygiene police of the Soviet era and the German tradition of social medicine.

Our delegation found another crisis in the works, around the creation of private health insurance that had started in 1990. Payroll deductions bought private health insurance that covered basic physician and hospital service. But that was just the start.

In Public Health Reports, I asked

"As the United States moves toward managed care and carefully structured incentives to make medical practice efficient, why did the Czech Republic choose private insurance companies and fee-for-service? Part of the answer is that the new system seemed furthest from the old command and control, and closest to pure market economics." But the Czech Republic did not stop there. "Twenty-two private insurance companies, founded with minimal reserves established with large bank loans, make fee-for-service payments all physicians who care for their policy holders."

No one seemed "to take responsibility for the decision to replace a Canadian-style fee-for-service system using a single insurance carrier that was in the original [1990] plan with 22 independent carriers." Why 22 insurance companies, I asked. As we probed, our Czech colleagues finally told us that it appeared that Hewlett-Packard (the US computer firm) had made payments to someone to assure that their software would be used. The H-P insurance software had slots for 24 carriers.

So, with a chance to adopt an efficient single-payer national health insurance system, the profit motives of a software company derailed the Czech plan. Imagine how much the US is wasting two decades later on a complex system that avoids national health insurance and allows software firms and insurance companies to rip-off billions of dollars.

Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy.  He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Program.

More like this

by Anthony Robbins, MD, MPA A recent editorial in the New York Times, "Rolling the dice on food-borne illnesses," focused on just one of the many health dangers related to the federal government shutdown.  The editorial reminded me of developments in Vermont almost forty years ago, when I was the…
By Anthony Robbins, MD, MPA I am always just a little skeptical about public health education.  Do students learn to apply the principles they learn?  Recently, I was able to answer in the affirmative, at least about a single occurrence. When I walked into the restroom of a Cambridge restaurant,…
by Anthony Robbins, MD, MPH When my colleagues here at The Pump Handle asked me if I would like to comment on the recent demise of "Single Payer" health insurance in Vermont, I hesitated because my Vermont hands-on experience is so dated. I moved on from being Vermont State Health Commissioner…
A regular contributor to The Pump Handle, Anthony Robbins, MD, MPA, and his co-editor Phyllis Freeman wrote the following editorial which is available at the Journal of Public Health Policy. In early July 2013, James R. Clapper, Jr, United States Director of National Intelligence apologized to the…

The business of all business is profit.

Providing insurance, much less actual health care, is a trivial concern for businesses. In fact, failure to provide services is just another opportunity to extract more payments in return for "improving the system' and/or providing premium accounts.

The same is true of credit card companies. They were told early on that easy credit card use and issuance would be a security nightmare. They ignored the warning because, in their dark little hearts, that identity theft and credit card account insecurity would open up doors for increased profits selling special "secure" accounts and processing.

Like Zeno's paradox you never arrive at the desired point, effective healthcare. You cover half the distance one overpriced increment at a time in a never ending series. In the end, exhausted and broke, you settle for what you can get.