Managed Care, It Seems, Is Now Just a Fact of Life

“Louise” lives in the Logan Circle section of Washington, D.C., in a five-story Victorian brownstone, though she also escapes on weekends to her farm in Virginia. “Harry” lives in Los Angeles. They’re not together anymore. Actually they were never together, at least not in real life.

“Harry” and “Louise,” as you may recall, were the husband-and-wife characters in ads that ran in 1993 that helped to sink the Clinton health plan. That legislation, spearheaded by then First Lady and now Sen. Hillary Rodham Clinton, was going to reform health care, or sink it, depending on whom you talked to. There was never any doubt about how Harry and Louise felt:

Harry: Government-run health care! Congress can do better than that!

Louise: They will if we send them a message.

Americans sent over 250,000 messages to Congress saying the Clinton plan was not the health care reform they wanted, an unprecedented show of grassroots support.

Now, as we begin the off-year election cycle, you hear . . . very little. Very little about evil HMOs. Not even much discussion about a patient’s bill of rights, which was supposed to make HMOs more legally accountable for denial of care decisions.

My guess is that cost is so much the issue now that the overblown complaints about improper withholding of care are yesterday’s news. Part of this may also have to do with the rise of consumer-directed health plans, which push much more of the responsibility and cost for care onto patients. Still, as recent statements from Sen. Clinton suggest, the managed care backlash may not be entirely played out. If there’s political capital to be gained from bashing HMOs, then who can say for sure that we’ve seen the last of Harry and Louise?

MANAGED CARE February 2006. ©MediMedia USA

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