For-Profit Accountability

Robinson makes comprehensible the labyrinthine political fightsthat surrounded the attempt by WellPoint to purchase CareFirst.He gives appropriate credit to the management of CareFirst forturning the failing Blues plans around while also noting howthey totally misread the temper of the Maryland legislature.He rightly notes that what looked like "a victory of peopleover profits" in Maryland looked to regulators in Delaware andthe District of Columbia as a rejection of "a conversion thatwould have generated millions of dollars for health-relatedprojects" while "forcing the firm to subsidize unprofitableproducts in Maryland with surpluses earned elsewhere." The heartof the issue, as Robinson notes, is whether nonprofit healthplans have an obligation to be more socially accountable thantheir for-profit competitors. We have all seen the bumper stickersthat read "Health Care Is Not a Business; Health Care Is a Right!"That may be a nice sentiment, but it does not describe today’sU.S. health care system. Health plans, whether nonprofit orfor-profit, are highly competitive businesses. All businesseshave an obligation to be both socially accountable and financiallysound, and many for-profit health plans do much more for theircommunities than competing nonprofit plans do. The "nonprofit/for-profit"distinction is a red herring. We need well-managed, community-mindedinstitutions that treat policyholders and providers fairly,regardless of their corporate form.

Lawrence H. Mirel

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For-Profit Accountability