An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

They accepted only younger, healthier patients on whom they could make a profit. They charged different rates, depending on factors like age, as they had long done with life insurance. And they produced different types of policies, for different amounts of money, which provided different levels of protection. Aetna and Cigna were both offering major medical coverage by 1951. With aggressive marketing and closer ties to business than to healthcare, these for-profit plans slowly gained market share through the 1970s and 1980s. It was difficult for the Blues to compete. From a market perspective, the poor Blues still had to worry about their mission of “providing high quality, affordable health care for all.” By the 1990s, the Blues, which offered insurance in all fifty states, were hemorrhaging money, having been left to cover the sickest patients. In 1994, after state directors rebelled, the Blues’ board relented and allowed member plans to become for-profit insurers. Their primary motivation was not to charge patients more, but to gain access to the stock market to raise some quick cash to erase deficits. This was the final nail in the coffin of old-fashioned noble-minded health insurance. Many of the long-suffering Blue plans seized the business opportunity. Blue Cross and Blue Shield of California was particularly aggressive, gobbling up its fellow Blues in a dozen other states. Renamed WellPoint, it is the biggest of the for-profit companies descended from the original ...