Health care at the brink

October 11, 1998|By Paul Delaney

IS ANYBODY out there concerned about where health care is headed?

Advice: You should be more than merely concerned. You should be scared. You should also be angry. No, furious.

Let's dispense with I told you so, although the inevitable should have been clear from the start.

Health care in the marketplace? The market dictates bottom-line considerations even as they clash with quality, access, etc. In the marketplace, poorer Americans are excluded and neglected by the millions, now approaching 50 million. That is criminal.

If health care in the United States was ever really the best in the world as touted by our politicians, it certainly is unraveling now. Best referring to how most of us are covered: not the rich, who will have the best care money can buy, or the well-covered (government workers at all levels), but the rest of us, working or not, whose health needs tending to.

So, as this monstrosity called managed care implodes, what will replace it? A growing number of experts says no one has a clue. During a series of briefings recently, it was frightening to listen to such conclusions from people involved in the system.

These folks described the situation this way:

* People running managed care know that chaos is coming, and they are mortified.

* Managed care is a giant Ponzi scheme so screwed up that no one has any vision of what will follow. Rules and regulations stymie citizens and seem to be a game between businessmen and lawyers trying to out-puzzle each other. And succeeding.

* Rate increases will be astronomical. Total cost of health care is predicted to go from $1 trillion last year to $2.1 trillion in 2007.

* The mood in the private sector is incredibly glum.

* The media are in cahoots with the medical industry, the advertising growth area, running more ads for health than for Safeway and Giant stores; meanwhile, critics say, journalists are lazy in their analysis of complex rules and industry regulations, written by lawyers and business leaders, and fail to give the public even a sense of the looming crisis.

Remember, the original objective of managed care was to reduce the cost of the nation's health bill by focusing on preventive care and shedding unnecessary and redundant procedures. Now the focus is on reducing costs, and most Americans firmly believe that health-care companies are more concerned with the the bottom line than quality.

The sound you hear out there is coming from us, a moaning that is turning into a collective scream. Loss of confidence in the system is similar to the loss of faith in globalism.

Some insurance costs are increasing by 50 percent. Large corporations can use their size as clout to keep costs lower than smaller companies, but quality suffers with fewer benefits.

Just about 50 percent of the nation's health maintenance organizations lost money last year. All HMOs in California are losing money. And this past week, a host of health companies pulled out of Medicare programs in 22 states, dropping coverage for 46,000 elderly people in Maryland, the District of Columbia and Virginia.

Surprisingly, Washington managed to turn attention to the crisis, mainly because angry constituents flooded congressional offices with complaints.

The White House expressed surprise at the withdrawals, and President Clinton criticized the HMOs for reneging on their commitment to the elderly. He ordered the Health Care Financing Administration to find replacement HMOs and expedite reviews of their applications.

Warning to Congress: We realize that not much will happen now, but the issue is a lighted fuse.

And as all those boomers become golden-agers and need more than cosmetic care, the explosion will be even greater. I don't want to frighten anyone unnecessarily, but some 40 percent of boomers will need long-term care. And they do know how to get attention when socked with high medical bills that threaten their assets and portfolios: call Congress.

Managed care has caused a major disruption in what most of us genuinely believe are life-and-death relationships with our doctors -- we don't want them referred to as "care providers," that's now jargon and a marketing device.

Who prods and pokes one's body is very private; Americans are used to choosing who does the poking. When some nonmedical, so-called manager makes decisions about extremely personal health matters, Americans find it insulting. They call Washington.

Those experts at the briefings who say no one has any ideas about the future believe health officials can put off the ultimate big decisions by dealing with small crises and puttering around the edges of those crises for the next 10 years.

In the end, they see a combination of government, the independent sector and the market fashioning some kind of solution to the mess we're in. With government representing we the people who were not part of the bargaining the last time around.

Paul Delaney writes from Baltimore.

Pub Date: 10/11/98

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