The health benefits community has been waiting for some force — a shift in employer preferences, a shift in insurer strategies, an upheaval in Washington or state capitals — to drop a hammer and smash everything to bits for decades.
People have been watching for the hammer ever since managed care organizations came along and smashed Indemnity Plan World.
Preferred provider organizations came along and loosened the grip of the health maintenance organizations, and health savings accounts came along and slowly revived the concept of imposing a meaningful deductible. But Managed Care World puttered along, never really changing in any dramatic way.