I started my healthcare career in 1978. I've seen a lot of change.

Back then, health insurance was basically an indemnity policy with a $500 deductible and 80/20 for the next $2K. That's it. The managed care movement started in the 80s and exploded in the 90s.

You can see how much non-physician overhead got added to cost. The ACA in 2010 started another climb.

On the payor side, we added medical management, payment integrity, PBMs, network contracting etc. If we had done nothing other than let member share grow with inflation the deductible would be $2K and 80/20 for the next $8K.

I ask myself everyday - Have we failed? Maybe doing nothing would have been better. The question has to be asked. What do you think?