Hard Questions Find Managed-Care Flaws

Washington’s failure to produce any health-care reform has had many lasting effects. The health-care industry was overdue for curbing escalating costs, creating more efficient management and reevaluating the monetary worth of health services, but exchanging exploitation for inefficiency is no cure.

The for-profit managed-care industry declares billions in profits while Medicare, Medicaid and the uninsured indigent seek funding. This has accelerated the unraveling of the underpinning of American health care by destroying the local safety net that guarantees everyone access to health care.

California physicians and other taxpayers are now asking hard questions about for-profit health care. This debate is timely because many communities are rapidly losing their safety net. When a hospital or emergency room closes, it closes for everyone. Over 6 million Californians--most of whom are working--and their dependents are uninsured. The law is currently stacked in favor of for-profit plans, requiring physicians and hospitals to evaluate all presenting patients for emergency conditions, regardless of ability to pay. Since few for-profit plans own hospitals, their exposure to the poor is “voluntary” and voluntarism is not profitable.

Our safety net can only survive by shared responsibility, which should include providers with little or no previous history of caring for the poor, predominantly for-profit health plans. Yet we have seen such plans quickly abandon CalOPTIMA, Orange County’s Medi-Cal managed-care system.

Should the safety net tear, the entire community will suffer with an increase in communicable disease, increased cost of treating more-advanced conditions, and increased chronic illness. A remedy does exist that would help bolster shared responsibility for the safety net. If a health-care entity had to match its “market share” of the healthy and wealthy with the proportionate share of the indigent and uninsured, this would put much needed new funds into the safety net. Such a “play or pay” system would help everyone meet their community responsibility.