The Managed Competition strategy for health care financing reform would push most people into cut-rate versions of health maintenance organizations chosen for them by their employer and owned by an insurance company. Many of those who currently enjoy good coverage would be forced into bare bones plans, and would forfeit the right to choose their health care provider. There is little evidence that the rigidly multi-tiered system created by Managed Competition would be more efficient or less expensive than the current U.S. system, and administrative costs would likely rise. Promises to expand coverage for the uninsured are likely to fall by the wayside if cost containment fails, and no current Managed Competition proposals address long-term care. In rural areas including at least 30 percent of the U.S. population, price competition central to the Managed Competition strategy is untenable since a lone hospital or other provider cannot compete with itself. Managed Competition would empower vertically integrated corporate health care insurer/providers and disempower patients and the clinical work force.
The following are excerpts from an article first published in the Health/PAC Bulletin in 1981. This lengthy analysis was written in response to various proposals made during the late 1970s and early 1980s to unfetter the invisible hand of free-market competition in order to solve the nation's health care "crisis." Twelve years later...the health care "crisis" is considerably more grave, and it has become even more popular to wave the "invisible" hand in the hope it will go away. Twelve years later, the objections Sigelman raises have not gone away either, and his conclusions--that in the face of the competition model, the need is greater than ever for consumers to organize to compel providers to deliver services that respond to the needs of the community--is, unfortunately, prophetic.
This article reports some of the results of a study of the content of drug treatment in New York City that is being conducted by Health/PAC's Drug Treatment Policy Project and funded by the Robert Wood Johnson Foundation. The research is led by a steering committee made up of clients of drug treatment services, providers and administrators of drug treatment programs, and legal and financial advocates for drug users. This article reflects 20 months of meetings and discussions by the steering committee; over 50 interviews with drug users, advocates, drug treatment providers, and program administrators about the experience, structure, and policies of drug treatment in New York City; and an analysis of the major evaluations of drug treatment services in New York City, supplemented by informal telephone surveys of facilities by staff. The Drug Treatment Policy Project has found services in New York City as a whole to be less than enlightened or adequate. But, in the course of the research, many programs were found to be both helpful and effective, mostly as a result of the efforts and personal risks taken by individuals who filled in gaps or by programs that, because they were community based, went to extraordinary efforts on behalf of their clients to make sure that a variety of options and services were available. We hope to outline these successes in another article.
This article is based on the author's presentations to the New York State Governor's Health Care Advisory Board's Task Force on the President's Health Care Plan, November 22, 1993, and to a hearing of the New York State Attorney General on the experience of consumers with health insurers and health maintenance organizations, September 20, 1993. His comments deal with the effects of the Clinton health care reform proposal and other forms of managed care on those most in need of care. Particularly interesting are his suggestions for protecting the rights of health care consumers.
In our first article reporting the results of a study by Health/PAC's Drug Treatment Policy Project, "Toward a Client-Centered Understanding of Drug Treatment" (Fall 1993 issue), we discussed the general inadequacy of public drug treatment services in New York City and the myriad obstacles that exist to obtaining treatment. This article maintains the client-centered perspective in examining an alternative approach that has been successful in helping drug users.
When we set out to review 'Mama Might Be Better Off Dead: The Failure of Health Care in Urban America" (Chicago University Press, 1993), former Chicago journalist Laurie Kaye Abraham's chronicle of one poor, urban family's battle to obtain health care, we discovered two things. First, the author had done a better job in her Introduction of briefly conveying what this rather singular book is all about than we might expect from a traditional review. Second, even in that short synopsis, Laurie Kaye Abraham had succeeded, in graphic terms that statistical and rhetorical abstractions cannot match, in showing why providing health insurance for the poor is not the same as providing health care and why any health reform plan that continues to ignore the needs of the poor will be doomed to failure. For these reasons, and with the publisher's permission, we are reproducing that Introduction here in full.
