editor's perspective

Uncle Sam is Eyeing the Managed Care Reins

BY JOSEPH T. BARR, OD, MS, EDITOR

Some doctors and some writers in the lay press recommend that doctors begin charging for telephone consulting, similar to what attorneys do, to offset what the HMOs are doing to cut their fees. They argue that the physician's quality of life has deteriorated to such an extent that qualified people are being deterred from entering the profession. Meanwhile, the money keeps flowing to big insurers. Some doctors in regions with a high managed care presence wonder if there is less regulation in socialist countries. According to Newsweek, "Everyone agrees that HMOs need some federal oversight and both parties support this." Well I don't.

I can't believe that Washington, D.C. republicans would agree with Teddy Kennedy and the HMOs themselves that a federal mandate to police HMOs and managed care plans is a good idea. This HMO Bill of Rights (HR 4250 -- the Patient Protection Act) is a ridiculous concept. Managed care was implemented to manage costs, with lip service paid to quality. Then people finally figured out that quality suffers ... it's Economics 101.

Managed care may be less desirable than free market care, but government oversight will only increase cost and bureaucracy. The American Society of Cataract and Refractive Surgery is right -- point of service options at the time of enrollment or even the time of care are important. We don't need managed care for managed care, we need more free enterprise for the direct providers, not some middle man making money and then some government program adding more cost. As Ken Sandker, my optometry school classmate, once said, "If you think health care is expensive now, wait until the government offers it for free."

You can laugh and say that that's not where we're headed, but perhaps you should think about what Teddy Kennedy said in Newsweek when asked about the new HMO oversight legislation which is pending. "You have to take things one step at a time," he said, acknowledging his long-term goal of building a national health care system "brick by brick."