In 2001, managed care our No. 1
Bioethics: Congress needs ...
by Arthur L. Caplan
OPINION
SPECIAL TO MSNBC
Dec. 21 — Events of the past year demonstrate beyond a doubt that managed care has failed — and failed dismally. The greatest single ethical crisis facing American health care as we move into the new year is what to do about it.
WHEN PRESIDENT Clinton put forward his plan in 1993 to fix America’s ailing health care system, it was met with enormous opposition by those convinced that the free market — not government — was the right treatment. Harry and Louise, the fictional “every man and woman” created by a coalition that opposed a more active government role in health care, warned in an endless series of commercials that Clinton’s plan would mean less choice and higher costs for the average American.
When the complex plan was rejected, Americans turned to the marketplace to control the exploding cost of health care, improve the quality of care and preserve their choice of provider and insurance plan. With its market incentives to drive down costs while improving quality and access, managed care, we were told, was the solution.
It is now almost a decade since Clinton’s plan went down in flames, bludgeoned to death by a powerful alliance of insurance companies, corporate lobbyists and medical groups. But managed care has not provided consumers with more choice or controlled health care costs. Instead, health care is in crisis.
THE GRIM STATISTICS
Why am I so sure that managed care is failing? Consider these grim statistics:
- In 2001, at least 1 million people lost their health insurance.
- By the end of the year, over 43 million Americans will be uninsured.
- Health care costs are again out of control, escalating at annual inflationary rates of over 11 percent per year.
The quality of care has not gotten better. Error rates, malpractice rates and basic measures of health quality are all stagnant or getting worse.
If these statistics are not enough to cinch the case that managed care has failed, consider these recent reports from the managed care front just from the past two months:
- The state of California fined the huge managed care plan, Kaiser Permanente, over $1,000,000 for failing to admit a 74-year old woman who subsequently died of massive internal bleeding from a burst blood vessel in her heart. This is cost control?
- The attorney general of New York is investigating managed care plans that are listing doctors as available for their enrollees when they are not. Not much choice there.
- In Massachusetts, a woman was denied coverage by her HMO for a liver transplant because she is HIV positive. Is discrimination the way to keep costs down?
- Also in Massachusetts, HMOs are levying an extra charge for anyone who needs care at an academic teaching hospital. So much for choice.
- Managed care plans in Pennsylvania are taking decisions about how long patients need care for drug and alcohol treatment away from treating physicians and psychologists and giving it to administrators, while constructing all sorts of bureaucratic and reimbursement barriers for those requiring mental health care. Where is the access and the quality we were promised?
Managed care plans all around the nation are raising co-pays and deductibles so that those who need care have to pay far more out of their own pockets than in the past. Well, that is one way to control costs and still make a buck.
Managed care is acutely ill. It is not doing the job the American people asked it to do. Congress should be paying attention but it is not.
The end result: It is costing you and me an enormous amount of money to keep the current mess afloat.
THE SOLUTION
It is time to start to treat health care for what it is — an essential public good that is not simply a business, or a perk of employment or a matter of charity.
Congress should create a commission that meets in public and would have the power to control price increases, limit deductibles, insist on access, and ensure the quality of care that managed care provides. The commission should solicit consumer complaints and work with federal and state officials to resolve them. And the commission should have the power to mandate coverage of health care benefits.
The Clinton plan died because it gave government too big a role in health care. Managed care is dying because government has too small a role. Congress needs to administer some very strong medicine to managed care — and fast.
Arthur Caplan, Ph.D., is the head of the Center for Bioethics at the University of Pennsylvania in Philadelphia.
Posted: 2001-12-21 |
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