American Health Care Blues: Blue Cross, HMOs, and Pragmatic Reform Since 1960

Scholars have been writing about the health care industry's social transition to managed care for over twenty-five years. American Health Care Blues is the first book to examine the special role of Blue Cross in this transformation. It tells the story of how national trade association leaders of America's loose confederation of independent Blue Cross plans, the world's largest private health insurer, got their membership to diversify despite local plan reluctance and national organized medicine resistance into HMOs over a thirty-five-year period. This radical shift, amidst rapid erosion of the nonprofit ethos in our society in the 1980s, seemingly reconstructed the conservative "Blues" into a more viable enterprise. It also dangerously eclipsed their guiding principle: "community service."

Making novel use of the sociology of organizations and pragmatic philosophy, Irwin Miller sheds new light on the nature and evolution of both the Blues and American health care voluntarism and reform. He shows how Walter McNerney, one of the primary health policy shapers over the past forty years, used ideological and utopian rhetoric to help move Blue Cross into HMO development. This case study of institutional and leadership behavior uses firsthand interviews, archival documents, oral histories, and other materials to present an unusually concrete and readable narrative account as to how health care leaders engage in creative institution building, or health care reform.

Miller's social history of Blue Cross also serves as a study in institutional conduct, providing insights into and explanations of leadership strategies for managing policy and institutional change. Fresh and revealing, and the book applies major theories of organization theory and dominant themes in pragmatic philosophy to shed new light on health care policy and reform. American Health Care Blues will be fascinating reading for sociologists, policymakers, economists, and professionals in the medical field.