Rise of Managed Care May Prompt Support for Health Care Reform, Boston Globe Op-Ed States

A "national dialogue about health care is beginning" in the United States, and although "there are reasons to doubt that large-scale health reform will take place soon," the rise of managed care may prompt voters to support health care reforms that failed in the early 1990s, New Republic Senior Editor Jonathan Cohn writes in a Boston Globe opinion piece. Many voters oppose the government expansion that would be required to establish a national health care system, and the small business groups and health insurers that "fought reform so vigorously in the 1990s ... will do so again," Cohn writes. However, he points out that "one key barrier to reform may be gone: the sense among middle-class Americans that their current insurance policies are sacrosanct." The rise of managed care in the mid-1990s limited patients to selected providers, led to questions of treatment decisions made by physicians and created longer waits for approved treatments, trends that "made the status quo a lot less appealing to the average American," Cohn writes. He adds that although many voters oppose the tax increases needed to fund a national health care system, the "nationwide epidemic of overcrowded emergency rooms" -- prompted in part by reductions in hospital operations that resulted from reduced reimbursements from health insurers, a "side-effect of the managed care revolution" -- could "motivate otherwise complacent, comfortable voters into supporting expensive health care initiatives." Cohn concludes that although the prospects for large-scale health care reform today may "seem pretty slim," the "plight of the uninsured and the anxieties of the currently insured are getting worse, and this means the political appetite for health care reform is likely to increase" (Cohn, Boston Globe, 12/1).