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.
