Wounded Profession: American Medicine Enters the Age of Managed Care

By Arnold Birenbaum | Go to book overview

6
Doctors Respond to the Dark
Side of Managed Care

For the medical profession, managed care has meant a reversal of fortune. The world of work is far more socially and economically complex than it once was, whether in the big academic health center in the big city or the small medical group in the leafy suburb. Incomes are remaining flat or beginning to fall. The warnings of the 1970s and 1980s by observers went unheeded, and now, doctors face the dilemma of whom they owe their allegiance to: the patient or the payer.

“May you live in interesting times”—an ancient Chinese curse—is the equivalent of being exposed to the evil eye at birth. And some doctors feel that fortune is followed by misfortune. The portents were there. The golden age of medicine represented the fat years, perhaps to be followed, as in the biblical dream of Joseph, by the lean years.

The decline of the medical profession’s status and power is as fascinating as medicine’s rise to power. Yet it is a domestic tale. In my meetings with people from other countries, often as part of my wife’s business travels, the subject of managed care is rarely mentioned when I let them know that I am a health policy analyst and a sociologist of medicine. Rather, they are most interested in how the United States could have more than 40 million Americans without insurance coverage of any kind. This baffles me, too, and I try to give my interlocutor a dynamic history of the organization and financing of health care in the United States. Needless to say, Europeans don’t understand how the richest nation on earth and the leading military power, can fail to provide appropriate

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