Managed Care: Made in America

Managed Care: Made in America

Managed Care: Made in America

Managed Care: Made in America


This book focuses on how a distinctly American product--managed care--got its start, how it works, and what needs to be adjusted in the future. As Birenbaum makes clear, this book is about social change. It is about doctors contracting with health maintenance organizations (HMOs) and being subject to their rules; about the limited access to specialty care; and about the frugal use of hospital admissions and stays. Consumers and providers have had mixed experiences in these health-delivery systems. Birenbaum, a health-policy analyst, has created a synthesis of research studies and analyses of trends to chronicle these developments and to suggest remedies to correct the most unjust aspects of managed care.


I think that if you look at the health-care issue, I think that I over- estimated the extent to which a person elected with a minority of the votes in an environment that was complex, to say the least, could make-- could achieve in a sweeping overhaul of the health-care system when no previous President had been able to do it for decades and decades, and against the enormous amount of organizational effort and funding that was spent to convince the American people of something that was not accurate--namely, that we wanted to have the Government take over the health-care system or that we wanted to regulate it with a cumbersome bureaucracy--neither of which was true, but I think they believed that. And I think people said, "Hey, that's not the kind of change we want."

--Bill Clinton, President of the United States of America

(Wines and Pear, 1996)

In 1992, as they do every four years, Americans elected someone who gave them a sense of the future. Bill Clinton had a mandate to improve the lot of the middle class in America, an amorphous cohort that included people near poverty and the denizens of the affluent suburbs. Clinton promised to do something for the people who worked hard, paid their taxes, followed the rules, and hoped for a better life for their children. He was tuned into how difficult life could be in America. The economy was going through some deep transitions related to the exporting of manufacturing as well as information processing jobs. For American workers, real wages were not rising and the purchasing power of the average family was stagnant.

Some of the problems of everyday life related to the high cost of . . .

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