How To Run Managed Care –If You Want To Destroy It

Usually it ill befits a magazine to take issue with its own past issues. But today I might rethink the opening line of the State Initiatives column in the May Managed Care. That column began, “The anti-managed care drive continues at the state level,” then went on to describe legislative efforts in various states to assure that treatment for conditions with symptoms meeting a prudent layman’s definition of “emergency” would be covered by health plans–even if, happily, the patient’s condition as diagnosed by a physician turned out not to merit retroactively the designation of a true emergency.

Are such laws “anti-managed care?” If they are, maybe managed care will be rescued by its enemies from the opprobrium courted for it by its so-called friends. Now that I think of it, if I wanted to discredit a system of health care financing and delivery, I’d have it provide a steady diet of the double-cross described by emergency physician Gregory Henry on page 34– his plight, that is, when that possible-MI patient he’s examining in the middle of the night had better be having a heart attack, because if it’s only indigestion the HMO will stiff him. And the patient, until he’s examined, truly does not know.

What else would I do if I wanted to invite first legislative tinkering at the edges, then perhaps a government takeover of my industry? Well, I’d send all new mothers roaring homeward within hours of giving birth, never mind the medical particulars, and I’d threaten physicians with the loss of their livelihood if they told patients the full truth about their own medical options or the way their doctors are paid. (To read about “gag” rules see pages 19 and 37.) I’d impose stingy limits on care and penalize physicians who deviated from them. But if these limits led to tragedy I’d make sure it was the doctor, not I, who landed in court (see pages 21 and 37). Finally I’d salt the wound by paying myself a million bucks (see page 20).

Isn’t it lucky managed care isn’t managed by its foes?

MANAGED CARE July 1996. ©1996 Stezzi Communications