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A Quarter Century of Health Maintenance
Mike Mitka
JAMA. 1998;280:2059-2060.
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IT WAS QUITE a year. Americans saw a Congress trying to pass legislation regulating health maintenance organizations (HMOs), a beleaguered president facing an impeachment inquiry, and New York and California baseball teams meeting in the World Series . . . welcome to 1973!
Twenty-five years ago, President Richard Nixon, while trying to avert impeachment, still had time to sway Congress and pass the HMO Act of 1973, a piece of legislation that legitimized a philosophy of health care delivery that ultimately changed the face of medicine. (And back then it was the Oakland Athletics defeating the New York Mets to capture the series.)
But what effects on medicine did the HMO Act actually have? Many experts say, "Not much." They note that managed care dominates the current health care environment because of employers who sought insurance alternatives in the 1980s when medical costs climbed at double-digit annual growth . . . [Full Text of this Article]
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