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Books, Journals, New Media
March 4, 1998

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

Author Affiliations

Harriet S.MeyerMD, Contributing EditorJonathan D.EldredgeMLS, PhD, Journal Review EditorRobertHoganMD, adviser for new media


Not Available

JAMA. 1998;279(9):713. doi:10.1001/jama.279.9.713

Between 1970 and 1990, America's Blue Cross and Blue Shield plans underwent a remarkable transformation. Until well into the 1960s, the Blues functioned as passive agents of doctors and hospitals, pooling patients' resources to maintain a reliable flow of revenue for services rendered. By the early 1990s, the Blues had become active managers of medical spending, challenging the economic power of health care providers and marketing cost control to consumers and employers.

Commentators typically tell the story of this transformation in impersonal terms, invoking such market pressures as employer demand for cost containment and fierce competition from commercial insurers. Irwin Miller's American Health Care Blues offers an alternative, less deterministic account—one that emphasizes instead the role of inventive, even visionary leaders.