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Managed Care or
Managed Cost?
UNH confab probes U.S.
health care ills
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Business New Haven
11/3/1997
By: Lori Green
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Part ribbon-cutting and part health care pow-wow, the University of New Haven's October 15 health-care symposium was the launch site for the university's new Institute for Health Care Management & Policy.
Attended by 175 health care providers and payers, politicians, public-health advocates, students and academics, the event featured prominent speakers such as New York Hospital's director of medical ethics, Joseph J. Fins, Yale University's Sherwin Nuland, M.D., Arnold S. Relman, M.D., editor-in-chief emeritus of the New England Journal of Medicine, and president-elect Nancy Dickey, M.D. of the American Medical Association.
After a morning of presentations, several guest speakers headed breakout panel discussions on issues related to their topics. The end-of-the-day objective was for the panels to report back to the plenary session with policy recommendations or directives on national health care reform.
Milton Wallack, D.D.S., chairman of the Symposium Planning Committee and a UNH director, described the event as a landmark gathering of all the players in the health care arena, who were coming to the table to develop what would eventually become a consensus on the future direction of health-care policy and services. “Our sense is that we can enhance access and quality in a more economic way and still allow for experimentation,” said Wallack.
Presenters such as Relman and Chapman, professor of health services management and policy at the George Washington University Medical Center, offered an historical perspective on the evolution of the nation's health care system that attempted to answer the question on most minds: How on earth did we wind up here?
“Here” refers to the current privatized, managed care-dominated environment, the main target of attack for the majority of the symposium's speakers. HMOs and the private sector barely had a chance to defend themselves, though they were represented by companies such as Anthem Blue Cross, GE, Bayer and ConnectiCare.
However, the litany of managed care offenses was not new. Charges of impeded access, comprised quality of care, exorbitant CEO salaries, under-served populations, meager reimbursements and manacled physicians have already been exposed.
A number of speakers and participants rallied around the call for a single-payer system. “Managed care filled a vacuum left by the bad health-care plan put forward by the Clinton administration,” said Relman. “It has brought temporary cost controls for the employer-paid sector, but the rest of the impact is negative.”
Relman said that the problems of Medicare and Medicaid would never be solved by market forces because HMOs are “not interested in people who have no money to buy health insurance.” The point was reinforced by Chapman in a series of slides revealing a continued lack of health services for the poor, documented in an HMO's proposal for Medicaid business in the D.C. area.
Employers, who foot the bill for health care for the majority of working Americans, were in short supply. Jan Speagele, vice president of regulatory affairs for the Connecticut Business & Industry Association (CBIA), reported that his group's membership had expressed high levels of satisfaction with managed care. Ten minutes was also allotted to Kevin Kelly, president and CEO of provider-owned MedSpan, who began by displaying the Chinese pictograph for “crisis,” which literally translated means also “change” and “opportunity.” Kelly then addressed the key issue of risk management and proposed that provider-owned private entities are best positioned to serve
consumers. BNH
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