MANAGING TO CARE

They call it “managed care”. Anyone who is covered by a health plan is or will be familiar with it. It is the privatized version of socialized medicine in which you must obtain the plan administrator’s permission to be sick. They come in two varieties. One variety is the PPO plan in which you get to choose from a menu of health care professionals, not necessarily MDs, who have contracted with the insurance company to provide the most economic – not necessarily the latest and most effective – health care. That Primary Care Provider is supposed to manage your care under the supervision, of course, of the plan administrator, usually an MBA. Then there is the HMO, usually operated by a consortium of health care providers one of whom you select or are assigned to as your Primary Care Provider to manage your care. Again your care is managed under the supervision of that new class of health care professional, the administrator whose job it is keep the cost of caring for you as low as possible. For either variation the cost of coverage is not low averaging from $4-6000 per person. In most families cost of coverage is partially paid as a benefit of full time skilled or professional employment. For many families whose incomes put them in the neighborhood of the government poverty line, working two or more part-time jobs to feed, house and clothe their children those job benefits are non-existent and coverage on an individual basis is beyond their resources. They must rely on governmental health care programs either entirely or partially funded by public money. They have no alternative.

The health care industry – I can no longer call it a profession – is always looking for new profit centers. For generations the poor have relied upon publicly funded or charity hospitals and their emergency rooms as the primary source of medical care. That reliance on emergency room doctors to provide care when an illness is too advanced to any longer ignore is not efficient, either medically or economically. Overused emergency rooms don’t produce profits, either for the hospital or for the PPO or HMO that contracts with it but primary care providers do. Paid by the head or the office visit by the health care plan, the primary care provider derives no income from unassigned patients who show up at an emergency room with an acute condition. Publicly financed plans for the poor pay lower per-capita rates than do the for profit plans so providers limit the number of poor patients that they will accept. The health care industry has looked to the MBA in Chief to help them manage health care for America’s weakest and most vulnerable and the President has delivered for them.

First he has decreed that the least able to pay may be turned away at the emergency room door and sent to swell the per-capita fees of the primary care providers – whose waiting rooms are already full. Second, he proposes that the medical industry be immunized from taking personal responsibility for their personal medical mistakes. Health care for the left behind children of America’s forgotten families is being managed right out of existence. I wish that the MBA in Chief could manage to care.