Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Saying "No!" (In the Style of Managed Care)

Managed care (or a reasonable facsimile) is "still with us….its role is certain to grow" and its "appeal is financial."

Tyler Cowen, a professor of economics at George Mason University, in "Managed Care: Get Used to It" NY Times writes that national bankruptcy would be considerably worse that managed care, even with all of its warts and "that’s where we’re heading if we don’t rein in health costs."  Clearly, "third parties — the government and insurance companies — won’t be able to pay for all the care that people desire." [Emphasis, mine.]

Our aging population and the technological imperative + the insidious nature of our litigious society = healthcare cost inflation.

He quotes Douglas W. Elmendorf, director of the Congressional Budget Office who says the administration’s cost-control proposals do not "reduce the trajectory of federal health spending by a significant amount."

First, do no harm

Is managed care injurious? "For all the complaints, managed care does not seem to hurt actual health care outcomes, whether pertaining to life expectancy or recovery from disease, according to a series of papers by David Cutler, an economics professor at Harvard, and co-authors."

The author is a realist

He says: "using the market to experiment with cost-control methods isn’t likely to be wildly popular. Still, it is better than relying on the federal government. It’s far from obvious that Congress, inflexible and besieged by lobbyists, will make better decisions. Congress also tends to promise cost control up front but to postpone significant action indefinitely."  

When push comes to shove, will it be a governmental or private managed care "No"?

Cowen posits that the perception of fairness is a factor and that some people may accept a "no" from a governmental program* over that from a managed care organization.  Nevertheless, "If so, we run the risk of limiting our care choices just because we’re more squeamish about one kind of 'no' than another."


*And for those who think health care reform equates to a government takeover, big brother is already paying a almost a half of the health care bill.

"Health Reform Myths" by Paul Krugman, NY Times, pub. March 11, 2010

Response by a nationally-recognized, physician executive

Sent: March 14, 2010 3:55:19 PM EDT

The legislation we have before us is an example of what the Government is likely to do with Health Care.  We start with the premise we need reform, cost is too high and excalating, and cost does not seem to buy quality.  So what do we have after a year?

We will provide for the uninsured by taxing health benefits (thereby increasing cost - and don't believe for one minute Union contracts will actually be exempt in the end), reducing Medicare budget (this will not actually happen - it can't - this will be replaced instead with more taxes).  We will also enact ineffective penalties for not having insurance - but we will still preclude carving out pre-existing conditions - so the cost of individual insurance will be beyond the reach of individuals.  The goverment will blame the insurance companies.  Since they don't print money (the government does) this will be a good pretext for a government take over - we have a crisis, make it worse/insoluble, then the only solution is a government takeover, with everyting papered over with higher taxes.

What is in this legislation to actually reform payment or practice.  A series of experiments (developed by the insurance industry) to try to apply what works for insurance companies to Medicare.  Rate this as possible, but highly unlikely to have real impact.  In this context, however, failure is OK as long as it can be blamed on someone else and used as a pretext to accomplish your agenda. 

Is this synical?  If so, why?