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Anthem’s Retreat: Hypocrisy, Corporatism, or a Step Towards Lean Healthcare?
Anthem Blue Cross Blue Shield is in the news for proposing policy that would cap coverage of anesthesia during surgeries with time limits. The debates that this decision triggered, which was later withdrawn, spilled over from medical, patient to policy sectors. To critics, the proposal seemed an unsettling reflection of the priorities of corporations; supporters saw it as a laudatory step toward lean health care. The controversy over the use of corporatism, ethics and efficiency in the provision of care is not a new, modern health care issue, but part of a long held debate in history and philosophy over the role corporatism and efficiency should play in healthcare provision.
A Historical Context
Tension between the profit motives and healthcare ethics is not new. In the late 19th and early 20th century, corporatist principles rose into fields governed under an ethic of service. As insurance models and for profit hospital systems came into being, healthcare started shifting to become an industry based in hospitals rather than being the community based, patient centered endeavor it had been for most of its history.
This historical trajectory consists of an association between financial constraints and healthcare decisions, which Anthem’s policy continues to do. A major chapter was written for this evolution with the appearance of managed care systems in the late 20th century. These systems were designed to cut costs and cut inefficiency and were usually charged with catering to the bottom line to the detriment of patient care. There is a sense that anthem’s actions are part of that historical pattern, at least in direct terms as corporations making healthcare policy decisions.
Philosophical Perspectives: Hypocrisy or Necessary Evolution?
Anthem’s proposal is from a philosophical perspective to bring us into a position of reconciling conflicting ethical frameworks. Essentially, much of the debate in this arena is between utilitarian principles and deontological ethics (principles which promote maximizing of resources for the greater good versus principles which stipulate that the intrinsic duty is to care for individuals).
