“Managed Care”  is the rationing of health care to the public on the basis of profit and loss.  Beginning as a method for removing  waste and duplication in the Health Care Industry  - with some success -  the Managed Care  Industry is now engaged in the only way left to be profitable: through limitation of medical and related  services.  This is rationing of the worst form, not politically based and poorly related to medical care priorities.

Nevertheless, business men and employers are comfortable with the system; and the U.S. Supreme Court, in an important case decided within the last year (Pegram v Herdrich, No.98-1949, 530 US __-24, June 12, 2000), stated that it’s legally OK.

Well, it’s not OK: not because doctors and hospitals are working harder  for less (at a time when their expertise and valued services to the public are increasing greatly); but because patients are being short-changed and are thereby suffering.

There is no free lunch.  Throughout the 1980’s, as the  Managed Care Industry was gearing up, doctors were substantially impacted.  But they made a conscious and successful effort to buffer their patients from the adverse effects.   Since the mid - 90’s,  however, the medical profession has been less and less able to do this.  They already have one arm and one leg in the dike.  And patients are not getting the care they have had and have a right to expect.

The problem is that the public has only a vague sense of unease and does not really believe the reports in McCalls and Cosmopolitan.  And the doctors are still not telling them the truth, because they are in denial, and even in depression.
The truth is clear: less care, less attention, less interest, less oversight, more mistakes;  and now, another developing crisis in medical malpractice insurance, not good for physician or patient.

It’s getting serious.  And only the patient / public has the political clout to treat the problem.  Legislators don’t listen to 800,000 physicians.  They listen to 150 million voters.  As noted above, the highest court in the land won’t do it.  And our fearless leaders are resisting risking the loss of millions of dollars in campaign contributions from the Managed Care Industry if they support legislative efforts like the “Patients’ Bill of Rights” - including the provision to permit suits against MCO’s that in effect practise Medicine without a license in order to improve their profit margins.  Health care delivery for insurance companies is a liability, a debit.  For physicians, other health care providers, and for the patient, it is an asset, the only asset, the reason for our existence.

What to do?  Physicians and other providers must become honest with themselves and must inform their patients of the situation in very clear terms.   The patient / public must then use its vast political clout to reverse the current practice of rationing health care without public approval and without medical justification - only for profit.  Unless our society agrees to pay whatever percentage of the gross national product  it will take to keep receiving the best medical care in the world and the greatest scientific break-throughs, it should  debate and decide upon a rational, fair, and medically grounded system of rationing health care.  But what is going on now is certainly not the way to do it.  There is a role for everyone in this battle.  And the stakes are clearly beginning to become issues of life and death.

GS