Chapter 3

Was the Country Ready?

Computers and electronic communications have extended the power of many businesses and other enterprises far beyond any limits foreseen in the past. Less than a generation ago most people never expected to communicate, transact business or rapidly accumulate knowledge by computer. Many of those who saw the advent of massive electronic communications also saw opportunities for control and power.

Extensive and rapid communications, access to personal information on many people, and a rapid shift of control from the individual to the owners of communication centers, created the opportunity to move control of health care from the physicians and their patients to the insurance companies and the employers.

The first owners of large nets of electronic communications in medicine were neither the physicians nor their patients. By the time the managed care companies had acquired control upon health information, physicians and patients were still expecting that they would make decisions on health.

When the employers allied themselves with the insurance-owned managed care businesses to exploit their new mastery in communications, most of the decision power in health care came to them in what now is called "payer dominance" (the one who controls the flow of patients, controls their care). This could have been prevented only if physicians and patients had the means necessary to create equally sophisticated networks.

The country was ready for the new system of care in so far as the employers wanted to control the health of their employees, the insurance companies wanted to make even more money, the new computer networks were increasingly sophisticated, the patients were unaware of the impending threat to their well-being, and most physicians either did not know or did not worry about the new situation.

Once the new masters asserted their control upon vast sectors of the health system, they engaged in a demonstration of unbridled greed. Every cent spent in health care was disputed, and often saved. Multiple strategies to prevent access to physicians, to make physicians and treatments invisible, to mislead future patients into contracts devised to deny care, to remove blocks of people from insurance programs, to deny effective medications, and to reduce intensity of treatment, were financially rewarding to the new masters.

The country was prepared for the new order in another way: consumerism and the desire for mastery of illness had emerged among patients and future patients. Not only had many community activists organized around groups of illnesses, treatments, or health issues, but they had acquired increasing mastery upon the issues they dealt with. The largest majority of these advocacy groups had excellent relationships with physicians, and were ready to fight together for the same causes.

As the community groups started reacting to the impositions of the new system, a new breed of legislators and lawyers emerged who was ready to provide effective help. Physicians went through a painful period of change until they also were willing to join the trenches as a fighting group.

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