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C om m e n ta r y
Managed Care, Rationing, And Quality: A Tangled Relationship Managed care, in defending its position against the current anti–managed care backlash, must demonstrate that it does, in fact, represent the “good guys.” by Emily Friedman
174 RATIONING & QUALIT Y
it h th e r ap id re st r uc t ur in g of the U.S. health care system and a massive increase in managed care enrollment, it was probably inevitable that a backlash would occur, especially with the profound redistribution of power and money these changes are causing. Although some consumer advocates, such as Sidney Wolfe of the Public Citizen Health Research Group, have criticized emerging large health care systems and for-profit health plans and providers, the most successful barrage of criticism has been targeted at managed care, the level of access that it affords (the “rationing” question), and the quality of the care it provides and/or pays for.1 The critics comprise a diverse (and often unintentional) coalition of entities with different goals and agendas. They include (1) some hospitals, physicians, and other providers, who are watching payers take over the health care system they once controlled and are not happy about it, especially given their diminishing incomes and revenues; (2) those in health care who are simply resistant to change, regardless of the nature of that change; (3) some elements of organized medicine and others, who condemn managed care for ideological reasons; (4) health care professionals and others who work in the field—many of them union members—who are worried about their futures and who are using the anti–managed care backlash to push job security demands; (5) a press that loves a scandal and that has been provided with substantial fodder, as some plans and systems have engaged in questionable behavior involving recruitment, enrollment, and access to care and providers; (6) politicians seeking to show sensitivity to press criticism and public complaints; and (7) Emily Friedman is a contributing editor to Hospitals and Health Networks and the Healthcare Forum Journal and section editor of the Journal of the American Medical Association.
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R A T I O N I N G
Q U A L I T Y
persons whose ultimate goal is a national single-payer plan and who thus condemn all other approaches, fee-for-service and managed care alike.2 n A distorted debate. This hodgepodge of critics with their various agendas unfortunately has...