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The Supreme Court has now planted the Affordable Care Act firmly among those needing healthcare coverage. Its 2015 decision in King v. Burwell begins with noting that Obamacare “grew out of a long history of failed health insurance reform,” and ends with the sweeping conclusion, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” So, why are the cost of healthcare in the United States and our infant mortality rate still higher than over 30 advanced nations? The book's second, expanded, edition offers a comprehensive overview of healthcare history, the factors, fictions, laws, and policies leading up to the Affordable Care Act. This indispensable resource by Professor Jack C. Schoenholtz offers page after eye-opening page information that explains the often overwhelming issue of the costly managed healthcare industry.This edition of The Managed Healthcare Insurance Industry--A Market Failure, intensifies its investigation of America’s healthcare. The book is written for the public who wish to understand the health and structure of the US healthcare system. It also reaches college-age youth, educators, and healthcare professionals--both providers and executives--and is excellent for legislators and regulators and their staff who attempt to reconcile problems that remain in healthcare delivery. It exposes the reasons for the remaining high cost of healthcare, and the byzantine way insurers have managed it and created the market failure that it is, costing society and patients more than it benefits them. By an analysis of historical and contemporary data, this revelatory and rigorously researched work brings facts from state and federal governments’ historical and judicial approaches to the public’s healthcare and the evolution of relevant statutes and regulations, together with the political economics and day-to-day medical and social issues surrounding the critically important doctor-patient relationship. The Managed Healthcare Insurance Industry examines the legislative and economic changes of the past forty years that resulted in the pre-Affordable Care Act’s millions of uninsured Americans. In Part I, the book highlights the onset of the healthcare “cost-containment” era, by way of the insurance-company friendly HMO Act, which led to the birth of managed-care insurance. Parts II and III helps unravel relevant federal antitrust law, particularly in terms of the power of federal “preemption,” and the 1974 enactment of ERISA, the “Employee Retirement Income Security Act,” so vital to pension benefit plans. Part IV illuminates the contributing factors that led insurers to “manage,” for profit, the delivery of healthcare by doctors and hospitals; and how by managing insurers' costs, left only a few giant insurance companies to control entire states’ healthcare systems. This section addresses whether insurers were legitimately cutting "costs of care," or care itself, by coercively manipulating prices in a predatory manner, and how patients, and their doctors, became reluctant participants in economically compromised care, and why this market failure became a deadweight loss for society. Parts V and VI demystify the business of insurance companies, and how formerly “risk insurance” policies became “noninsurance,” which exploits employers and their employees’ benefit plans alike by keeping their administrative costs artificially high. Parts VII, VIII, and IX explore managed healthcare as an economic market failure that results in a waste of resources. Parts X and XI discuss the legal attempts by the commercial insurance industry to dislodge congressional will in enacting Obamacare, bringing up-to-date the attempts by the industry to control the new Exchanges and Accountable Care Organizations so powerfully resolved by the Supreme Court.
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In this second, expanded edition, The Managed Healthcare Insurance Industry--A Market Failure intensifies its investigation of America’s healthcare crisis now that the Supreme Court has decided the constitutionality of the Affordable Care Act, "Obamacare." The book is written for adults, college-age youth, educators, and healthcare professionals--both providers and executives--and for legislators, regulators and the public who have concerns about the health of the US healthcare system. It exposes the reasons for the high cost of healthcare, the byzantine way commercial outsiders have managed it and created a market failure--costing society and patients in need more than it benefits them--and how the federal Medicare and state-run Medicaid programs began to funnel their money directly to the for-profit healthcare insurance industry. Most media pundits and economists approach such issues largely from within their own disciplines making the debate more confusing than clear. Consequently, by a fact-based analysis of historical and contemporary data, this revelatory and rigorously researched work explores multiple points of view and weaves them into a meaningful message. It brings together news media reports, state and federal governments’ approaches to the public’s healthcare, the evolution of relevant statutes, regulations, Supreme and appellate court decisions, the 2012 appeal to the Supreme Court by 26 states' attorneys general and the insurance industry to invalidate the ACA, and the political economics and day-to-day medical and social issues surrounding the doctor-patient relationship. Why are the cost of healthcare in the United States and our infant mortality rate higher than 33 advanced nations? The book's second edition offers a comprehensive overview of the factors, fictions, laws, and policies leading up to the pre-ACA managed healthcare insurance predicament. This indispensable resource by Professor Jack C. Schoenholtz offers readers page after eye-opening page information that explains the often overwhelming, ever-important issue of managed healthcare. In clear, unflinching language, The Managed Healthcare Insurance Industry examines the legislative and economic changes of the past thirty years that have resulted in today’s increasing number of uninsured Americans. In Part I, the book highlights the onset of the healthcare “cost-containment” era, by way of the insurance-company friendly HMO Act, to the advent of the managed-care industry. Parts II and III tackle the implications of federal antitrust law, particularly in terms of the power of federal “preemption” as birthed by the 1974 enactment of ERISA, the “Employee Retirement Income Security Act.” Part IV illuminates the contributing factors that lead to companies created to “manage” externally the delivery of healthcare, how most failed to survive or swallowed their rivals. This section addresses whether insurers were legitimately cutting costs or coercively manipulating prices in a predatory manner, and assesses the healthcare “monopsony,” wherein patients have become reluctant participants in compromised offerings, and why this set up a paradigm of market failure—a deadweight loss for society. Parts V and VI demystify the business of insurance companies, and when their former “insurance” policies became “noninsurance” that exploits employers and their employees’ benefit plans alike, keeping their administrative expenditures artificially high. Parts VII, VIII, and IX explore managed healthcare as a market failure that results in a waste of resources. Parts X and XI discuss the legal attempts by the commercial insurance industry to dislodge congressional will in enacting Obamacare, its attempt to enter and control the new Exchanges and Accountable Care Organizations; and it concludes by weighing the medical ethics of doctors’ participation in managing managed care.
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