No Magic Elixir Can Cure Managed Care

Article excerpt

Is managed care unfairly criticized?

It appears that managed care is the popular scapegoat -- it's been blamed at one time or another for everything from shoddy health care to employers' shrinking budgets.

And managed care is in the hot seat again, thanks to government proposals for a patient's bill of rights that would increase patient rights in lawsuits against insurers.

Some consumers seem to think this a resolution well overdue.

Consumer advocate groups, like Consumers for Quality Care, feel that "Wall Street-driven" HMOs and other for-profit health care corporations are "often putting profits before patients' health," according to their Web site. During the 1998 Congressional session, this group regularly faxed 1,000 legislators daily for five months with a different photo and story of patients whose deaths the group felt were the fault of the insurer.

And consumer unhappiness with managed care made a patient's bill of rights one of the top issues for the recent presidential race.

Admittedly, problems exist in the health care industry, just as in any industry, and people want someone to blame. Managed care seems to be the scapegoat.

The term "managed care" is villainized by consumers and politicians, but just a reminder: managed care isn't a person -- it's a system.

In this system, insurers negotiate discounted prices and coverage contracts with health care providers. As part of this negotiation, insurers generate a patient base for hospitals, doctors and clinics by funneling their members to these providers, who in turn offer lower rates for the group.

In the early 1990s this system made health care affordable and accessible again after prices rose too high.

There is no modern-day dictator of managed care rushing pregnant women out of a hospital or limiting prescription drug coverage. …