Must Good HMOs Go Bad? — The Commercialization of Prepaid Group Health Care

Prepaid group health care began in the 1940s as an insurgent, even radical form of medicine. At the time, few Americans had health insurance. The early programs would later be called group or staff models — closed systems with salaried doctors and an emphasis on prevention. The members sacrificed an often hypothetical freedom of choice for security and continuity of care. The doctors sacrificed independent, fee-for-service practice for a stable salary, a collegial setting, and a social ethic. Such plans were fiercely resisted by organized medicine.1,2 The shift in prepaid group health care from an insurgent social movement to . . .