Register Looks at the Uncertain Future of Managed Care
The Orange County Register examines the fragile state of managed care in California, noting that its "promise[s]" of reduced costs, improved quality and a stable health care system "have given way to a system in crisis with no clear path to the future." Despite the uncertainty surrounding managed care, the Register reports that most health "industry players" have agreed on "some" issues:
- Consumers will have to shoulder a greater burden of health care costs. As premiums rise, employers have begun to pass off more of the costs to employees through higher deductibles and co-payments;
- "[N]ew, expensive, cutting-edge drugs and technology" will continue to enhance the quality of health care, but will also "impos[e] mounting financial pressures on the health care system and exacerbate tensions between health plans, doctors and hospitals";
- If premiums grow as projected, the ranks of the uninsured will continue to rise;
- While "ferocious competition" between payers and providers will lead to "more shocks to the system," such as KPC Medical Management's bankruptcy, they also "could lead to a shakeout of the weakest-performing physician groups, leaving the ones that are strong and highly committed to quality care"; and
- Managed care is "here to stay," as the federal government is "not going to step in and fix the system" (Wolfson/Bunis, Orange County Register, 2/16).
Meanwhile, Paul Ellwood, the man credited with inventing the term "health maintenance organization," now views managed care as a system where, "instead of the consumer being in the driver's seat, large health insurance companies run the show," the Orange County Register reports. Ellwood and other managed care "pioneers" intended to create a system in which costs would be controlled, quality improved and "the veil of secrecy" around medical decisions lifted. However, Ellwood said that he and his colleagues should share part of the blame for today's problems with managed care, as they "spent too much time kowtowing to big businesses and big insurers." He said, "We were unsuccessful in getting beyond these powerful interest groups to reach individual consumers." But Ellwood "save[s] his harshest criticism" for the Clinton administration, which was "hostil[e]" to the managed care industry and "condemned the people who were providing health care in this country." Ellwood said that Clinton's failed attempts to reform the health care system are responsible for the "trivial" health proposals offered by Al Gore and George W. Bush in last year's presidential campaign. Ellwood now favors "moving toward universal coverage through tax credits and tax exclusions, and making health insurance mandatory." But like others, Ellwood believes that the future of health care is uncertain. "I'm no longer trying to figure out what the best way to deliver care is going to be," he said (Bunis, Orange County Register, 2/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.