by Anthony Robbins, MD, MPA
President Obama’s health reform has been derailed in a collision with health insurance software, but this is hardly a unique experience. In 1995, I was invited to Prague to try to help the Czech Republic reconcile two co-existing public health practice cultures–the hygiene police of the Soviet era and the German tradition of social medicine.
Our delegation found another crisis in the works, around the creation of private health insurance that had started in 1990. Payroll deductions bought private health insurance that covered basic physician and hospital service. But that was just the start.
In Public Health Reports, I asked
“As the United States moves toward managed care and carefully structured incentives to make medical practice efficient, why did the Czech Republic choose private insurance companies and fee-for-service? Part of the answer is that the new system seemed furthest from the old command and control, and closest to pure market economics.” But the Czech Republic did not stop there. “Twenty-two private insurance companies, founded with minimal reserves established with large bank loans, make fee-for-service payments all physicians who care for their policy holders.”
No one seemed “to take responsibility for the decision to replace a Canadian-style fee-for-service system using a single insurance carrier that was in the original  plan with 22 independent carriers.” Why 22 insurance companies, I asked. As we probed, our Czech colleagues finally told us that it appeared that Hewlett-Packard (the US computer firm) had made payments to someone to assure that their software would be used. The H-P insurance software had slots for 24 carriers.
So, with a chance to adopt an efficient single-payer national health insurance system, the profit motives of a software company derailed the Czech plan. Imagine how much the US is wasting two decades later on a complex system that avoids national health insurance and allows software firms and insurance companies to rip-off billions of dollars.
Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy. He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Program.