Will Politics Change Managed Care’s Rules?


I once did some volunteer work for an idealistic young candidate who was running in a primary against a man I'll call Congressman X. X, an influential legislator, had been tainted by the Abscam scandal of the late 1970s, and that perceived vulnerability had also drawn two latecomers into the race. I still recall the remark of a wizened observer in the back of the hall at a candidates' debate shortly before the incumbent squeaked through to renomination. “You might be able to beat Congressman X,” the man said. “But not with three candidates!”

I thought of that remark while reading about Propositions 214 and 216 on this month's California ballot. Both were aimed at perceived abuses in managed care, and both looked like losers as Election Day neared. One reason: As the Wall Street Journal reported, “proponents of the two initiatives seem to devote as much energy [to] attacking each other as they do [to] their mutual opponents.” Another factor working against the two California propositions was the voters' overall mood. Analysts say 1996, unlike '92 and '94, isn't likely to be a bad year for incumbents. And in California, managed care is by now so entrenched as to have assumed the character of incumbency.

That's also true up the coast in Oregon. Because of our deadlines, readers of this page have the advantage over me in knowing the numbers in the lower right hand corner of our cover– the vote tally on Salem ophthalmologist Gordon Miller's Measure 35. Defeat seemed in store for that initiative, too. But we considered Measure 35 worthy of a closer look, because it dealt not with gag rules, gatekeeping or 48-hour maternity stays, but with capitation, a payment mechanism at managed care's core.

By now, surely, even the hardiest citizens are tired of politics. But the political process has the power to change the rules of managed care. We present our article on the implications of the Oregon vote (page 26) in the belief that, whatever this fall's results, the views of patients as voters can't be safely ignored.