Picture it: Long Island, New York, 2004. (For anyone old enough to remember “The Golden Girls,” I hear the voice of Sophia Petrillo saying “Picture it: Sicily, 1941.”) I owned a moderately successful insurance agency in Hauppauge, New York. There were eight of us working there, we had a bevy of good clients, all of them fully insured, and we had what appeared to be, by today's standards anyway, a robust and competitive insurance marketplace.

My life consisted of putting a spreadsheet together to get the client and hoping I showed something their current broker didn't, even though they had access to the exact same plans and rates I did (New York had been truly community-rated for a very long time). Once the plans were chosen, I would conduct employee meetings and my staff would help service the group throughout the year. At renewal, I would almost laugh at the increases year after year, and watch as benefits eroded to offset the rising premiums.

But we didn't call it “erosion” at the time. Oh no! We called it “consumerism.” We drank the Kool-Aid and talked about a day when patients, with more skin in the game, would be better stewards of the plan dollars now that they had in-network deductibles.