editor's perspective

Health Care Reform Isn't
 (Bad for Contact Lenses)

BY JOSEPH T. BARR, OD, MS, EDITOR
April 2000

I saw the bumper sticker again the other day that reads: "Managed Care Isn't." Recent stories about health insurance company lavish parties and high salaries tell the old story. When health care costs skyrocketed, the strategy was to keep the money from those greedy doctors. Indeed, the money has flowed to the insurance companies, who try to minimize reimbursement while boosting their own employees. That's management all right--managing where the money does not go: to improve care or doctor-patient relationships.

The same government who tried to sell a massive federal health care plan in Clinton's first administration has a new plan: the "Patient Bill of Rights." So the government and industry force managed care on us, and then they say it didn't work, let's make it a law that doctors must care for patients. I thought that's what doctors did in the first place. A campaigning Bill Bradley said 44 million people in the United States are uninsured. That's sad. But I can't figure out why no one seems to mention the millions of dollars worth of care that health practitioners provide at no charge. This includes volunteer work, providing care for a patient who can't pay or all the "managed care" without reimbursement. Rumors of more doctor unions (an idea I don't like) make you wonder if what we should really be talking about is a "Practitioner Bill of Rights."

Recent AOA publications say we'll see a practitioner oversupply this decade, based on current distribution and demand for services of a few thousand too many O.D.s . I tell optometry students they should consider going out of the country, or even North America, to practice. Becoming an expatriate may not be very appealing, but they'll find more opportunities and less managed care elsewhere. You would think competition, along with too many U.S. optometrists and ophthalmologists, would manage the cost of care simply based on a free enterprise system.

What does this have to do with contact lenses? Too many eye care practitioners will likely drive down the cost of contact lens care to the consumer. That may stimulate demand, even if practitioners have less incentive with lower per-patient profit. However, consumer advertising and promotion of frequent eye examinations by contact lens manufacturers will bring in patients asking for and getting new, improved contact lenses. And because most of contact lens care is still free enterprise, not managed care, we will continue to see contact lens use grow in this decade based on population demographics . . .despite refractive surgery and a "Patient Bill of Rights."