MANAGED CARE: Focus Of Time Cover Story
Time magazine's cover story this week examines the debate over the need for reforms in the nation's growing managed care industry. The cover features a stethoscope and the headline: "What Your Health Plan Won't Cover." Time sets up its coverage by noting Kaiser Permanente's recent decision "not to cover the cost of the $10 erection pill" Viagra. "Just three weeks later," the article continues, "the little pill had become a symbol of one of the nation's hottest political issues: what HMOs do and don't pay for." Time looks at a "sampling" of HMO "horror stories" before offering its assessment of why managed care reform has become such a potent issue. According to Time, "like every other revolution, this one produced its excesses. After they had cut the obvious fat, managed care groups began cutting into the bone. Under pressure to keep lowering expenses, health plans focused more and more attention on cost control. Some administrators started making penny-wise, pound-foolish decisions, disapproving preventive steps and then paying for expensive operations down the road." The article continues: "In theory, the marketplace should provide a check on health plans that cut too far. ... But that assumes there is competition and free choice. Most employers let their workers choose from only a handful of plans. Industry consolidation, meanwhile, is reducing competition even further." Paul Ellwood, one of the original developers of managed care "theory," said he is "disappointed ... with the system he helped create." He said, "The idea was to have health care organizations compete on price and quality. The form it took, driven by employers, is competition on price alone."
Quality As Savior?
Time reports that "a growing number of experts believe that quality control is the crucial innovation that could save managed care." Employers are increasingly interested in quality measurement, and it is employers with whom "the real power rests," the article notes.
The article concludes: "Whichever way the Viagra wars turn out, there is no going back. Gatekeepers and cost controls will always be with us. In the end, each of us is going to have to learn to play the managed care game. And if we can't get what we need from our health plans, we're going to have to speak up, not just to the nurses and doctors but to our employers as well. After all, they're the ones that picked our plans and pay the premiums. And they're the ones with the financial clout to change the rules of the game" (Dowell et al, 7/13 issue).
Time also looks the politics of managed care reform in two separate sidebars ("Let's Play Doctor" and "A Republican Who's Taking His Medicine"), and a third piece ("Ahead of the Feds") looks at how some states are moving to reform managed care (7/13 issue).