Many of us are familiar with Charles Darwin's 1859 book, "Origin of Species." Darwin wrote several other books subsequent to that seminal work. In 1871, he addressed hominid (humans and our predecessors) evolution in "Descent of Man." Though many thought Darwin to be the preeminent naturalist of his day, his central thesis in "Descent" was presaged eight years earlier by someone whose name remains virtually unknown.
In 1863, Darwin's fellow Brit, Thomas Huxley, a biologist, wrote "Evidence as to Man's Place in Nature." Unless this was your field of study in college, you may never have heard of Huxley, but you are probably familiar with an illustration — or a parody of that illustration — from the opening pages of Huxley's book. Benjamin Hawkins, a sculptor and artist of the day created a drawing of a sequence of skeletons progressing from lower to higher stages of development.
In the 150 years since Hawkins created that illustration, we have seen countless parodies of it. Some start with a hunched over ape and sequence through man standing upright reading a book before ultimately ending with an ape-like human in a posture similar to the first ape, but hunched over a computer instead. The caption is, "Somewhere, something went terribly wrong."
Last night I had dinner with a bunch of non-insurance friends. Despite my best efforts, the conversation managed to wend its way to PPACA. Somewhere between cocktails and the main course, someone asked a question that brought to mind a health care-related play on that very same cartoon. Drawn by award-winning cartoonist Roger Schillerstrom for a 2004 issue of Business Insurance magazine, it showed health care rising from the ooze, becoming an HMO, then a PPO, and then — walking upright — the fully evolved Consumer-Driven Health Care.
My friend mentioned Sen. Max Baucus' (D-Mont.) recent comment that he is "very concerned" exchanges won't open on time, and even if they do, consumers won't have the information necessary to make informed decisions. Challenging Health and Human Services Secretary Kathleen Sebelius, Baucus said, "I just see a huge train wreck coming down." He continued, "The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade." He told Sebelius, "You need to fix this."
Another of the folks at dinner asked if he was recalling correctly that Baucus was one of the prime authors and drivers of PPACA in the Senate. I affirmed his recollection, and he asked me the question that too few have asked: "How in the hell did we get here?"
Hoping that his question was rhetorical, I summoned the waiter and bought another round of drinks. They had not even arrived when he pressed, "When I was a kid we didn't have all of this crap, mom just took us to the doctor and paid the bill. So how did something that worked get so fouled (not his exact word, though his started with the same letter) up? Explain that to me!"
I took a big gulp of air (and a bigger gulp of my bourbon) and suggested that if he were to ask the same question of a group of benefits pros, he would likely receive many different answers. Somewhere between kindly Marcus Welby (Google it, youngsters!) and today's maelstrom we created — or at least aided and abetted — the development of a completely untenable, unsustainable and unimaginable tangle of competing interests that ultimately served no one's purposes.
Some of those practitioners would likely point to the IPA (independent practice association) model, where an HMO or insurer contracts with individual physicians. Mix the complete and total inefficiency of multiple, repetitive physicians' offices with massive amounts of litigation resulting in seven (or more) figure settlements. Add in a completely disconnected information grid and a system lacking even the most rudimentary ability for those disparate physicians to work together on diagnosis or treatment and you have the beginnings of the recipe for disaster.
