So Clinton sought to cage managed care inside managed competition, which would regulate the behavior of insurers and force them to compete for patients. This would give consumers more power against their insurance companies, drive the bad actors from the market and generally protect against the excesses of managed care. Clinton’s plan also included a handful of other safeguards, like out-of-pocket caps and an independent appeals process, designed to protect consumers from deficient insurance…

But if Clinton’s team of enlightened wonks could glimpse managed care over the horizon, the public wasn’t as farsighted. Bill and Hillary weren’t seen as meeting and taming the managed-care revolution. The act of writing legislation that included managed care made it seem as if they were proposing it. And there was no political margin in that. Managed care, after all, means less choice. It means provider networks and insurance bureaucrats and complexity. It would have been a hard sell under any circumstances, but the Clinton administration’s chaotic political operation and continual drip of scandals made the job virtually impossible. The plan died a painful and public death in Congress and contributed to the GOP’s huge gains in the 1994 elections.

But then a funny thing happened: Managed care came anyway. By last year, only 7 percent of American workers were in “traditional” indemnity health plans, while the rest of us — or at least those of us fortunate enough to have insurance — were swimming in the alphabet soup of HMOs and PPOs and HDHPs. We’re all in networks now. We don’t get our choice of doctor. There’s no appeals process. No out-of-pocket caps. Nothing to stop insurers from rejecting our coverage applications based on preexisting conditions. And if we don’t like our insurer? Tough.

Read it all.

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