Quentin D. Young
President-Elect, American Public Health Association
Summary of Paper:
The Case Against Profit-Driven Managed Care
Presented at
Envisioning Ethical Atlernatives in Health Care
9 December 1996
Summary:
HMOs like Kaiser Permanent and HIP were wonderful innovations—economy of scale and group prac-tice and emphasis on
prevention—that brought health care to a lot of working people in America. They're not to be confused with today's
for--profit corporate-run HMOs. Until we get that clear, we are going to be using a jargon that makes no sense.
The efficient managers of the new managed care systems are charged morally, ethically, fiscally, and legally to maximize profits for the investors. A proper health care system should be animated ultimately to heighten the health status of the nation's population.
Let the United States join the rest of the human race, at least the Western industrial world, and recognize that health care is a right. It is a responsibility of society to assure health care. We are in the process of abandoning our social responsibility for health care. We cannot let that happen. We need to enact a national tax-based insurance, Medicare for everybody, and end the destructive linkage of insurance with employment.
Managed care is destroying carefully crafted arrangements in this country. Patient choice is disappearing. Physician incentives are being subverted. Infrastructure is being pulled out. The nursing profession is being deprofessionalized as we talk. It has been accomplished with breathtaking speed. Today, we have all these untrained people who are displacing nurses at great patient peril. And, of course, the same kind of thing is going to happen to the medical profession next.
Doctors now are being forced to choose in a very fundamental way, whether they're going to ride with the hounds, which I equate with supporting the corporate takeover, or with the hares, their patients. The only way physicians can survive as a profession, with their morality intact, their prestige intact, and their ability to care for patients intact, is if, in larger and larger numbers, they see the need for unity with the patients in these desperate times.
We are already approaching an oligopoly. The economist John Kenneth Galbraith has said, "Oligopolies don't compete. They share." And that is what, of course, is happening. We're getting down to six or eight big HMOs, and it has been suggested that, as in Minnesota, it will become one or two big ones. And despite all that has been said, these HMOs are, at this stage, on their good behavior. They are trying to win people and penetrate markets. If you want to see how tough they can be, wait until they control a market.