Research Proposal on "Where Is Healthcare Going in America?"

Research Proposal 5 pages (1623 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Health Care in America: The Pendulum Swings

When managed care appeared to have the American health care system in a strangle-hold, health care executives began giving speeches that described how the managed care entities were trying to stabilize an industry that had seen run away costs, and was alleged to have committed patient and insurance fraud and abuse by unnecessary surgical procedures and fraudulent billing practices (Sparrow, Malcolm, 200). The executives described the grip that insurance company's managed care programs were putting around the neck of health care as a pendulum that was swinging in an exaggerated direction away from the center of health care delivery quality of care and physician-based decision making on behalf of patients (Nickelson, Daniel J., and Saksena, Sanjeev, 1994). The pendulum, health care executives said, would adjust itself to the needs of patients and providers, and swing left towards the center of industry balance (Nickelson and Saksena, 1994). The pendulum has remained frozen to the right to health care quality and the needs of health care providers for more than two decades now. Frozen to the right as if frozen in time, the pendulum shows no sign of swinging to center, and, indeed, to do so would be contrary to the defined meaning of "managed care."

Today, health care is in a state of chaos, and appears to be morally bankrupt. Patients are not the first consideration in the delivery of health care, rather, the cost of the delivery of the care is weighed against the diagnostically related group (DRGs) into which the diagnosis falls, and by which managed care entities who oversee and approve patient access to benefits determine whether or not the diagnosis and the cost of care will change the outcome of the delivery of care. It is a financial decision, made by overseers of employer and private health benefit plans who could be thousands of miles away, and, today, even in a different, non-English speaking country, which gives rise to grave concerns about information exchanges between professionals, patient privacy, and confidentiality. Health care delivery, as it stands today, is irreparably damaged such that industry officials and political leaders caution it moving towards even greater disaster.

Understanding Managed Care

Understanding managed care, that component of health insurance that is included in nearly all plans these days, means asking the question: what is it. It is a largely unregulated and business focused aspect of health care delivery (Birenbaum, Arnold, 1997, p. 13). This means, that while health care as a service to patients is heavily regulated by state governments, the federal governments, and have oversight by independent agencies outside of the state and federal governments, as well as within those bodies; managed care organizations remain exempt from any oversight whatsoever; except those of the Securities and Exchange Commission that would perform oversight in terms of the financial and banking laws governing publicly traded companies (Birenbaum, p. 13). Such oversight has nothing to do with the quality of patient care, or the delivery of quality care.

Economist, health care delivery expert, and author Arnold Birenbaum says:

Managed care defies our common-sense understanding of value in the world of work and in the area of health care. Advocates of managed care challenge conventional wisdom when they claim that doing less produces a greater outcome for the patient than taking action as well as promoting the common good. Economists in the nineteenth century believed that all work can produce something of value. Usually, the more we do, the better off we are. Thus, more value is added to what is produced. So when you extract iron ore from the ground and add carbon to it under intense heat, steel is produced. For some economists, human labor is what creates the value in the product and not just the fact that now it can be sold in the marketplace. A similar process takes place in protecting human life and fighting disease through medical interventions (Birenbaum, p. 13)."

By surrendering the American health care system to managed care, Americans have allowed themselves to be into diagnosis classifications that eschew the human factor in health care. Since health care is about attending the medical needs of patients suffering everything from colds, to influenza, to terminal cancer, eschewing the human factor should be distinctly noticeable. Therefore, the only surprise that managed care should bring to people is that surprise which comes from the fact that the average person, the insured person, has no idea what managed care is, or of the impact it has on their health.

Today, most people insured under group benefits plans were born in the era when managed care was tightening its grips on America's health care systems. The young Americans who constitute the largest number of people insured under employer group benefit plans today, have never experienced a health care delivery system wherein physicians had complete control of their patient's care, decision making in treatment, and services rendered in the care of the patient. Just as many lay persons have not attempted to sort the meaning of quantum physics as it pertains to the universe, nor have people with insurance been inclined to understand the meaning of managed care in their lives; though the latter is clearly less complex than the first, and has perhaps more direct impact on their lives, and certainly during their lives.

Health Care Talk Wins Votes

There was a time in American history, that time before managed care, when political candidates could not use Americans' health care benefits as a way to lure votes for public office. Twenty-five years ago, the politicians agenda was limited to education, Social Security, government spending, and whatever hot topic of the day was causing Americans to be disgruntled; which also causes Americans to be more critical of political spending and waste. Today, as we watch the news and watch the presidential and even vice presidential debates, we see that health care is a major issue on the campaign trail. Each candidate, and their potential VP, is serving Americans a buffet of health care reform. What is, or should be, drawing the attention of Americans like a sore thumb regardless of the flowery rhetoric, is that neither candidate has used the words, "managed care." Managed care is what is wrong with the system today, and for that reason it is very noticeable, and baffling, that neither presidential candidate has served the words with their health care reform ideas.

The reason for this is that any plan that is implemented regarding Americans' access to health care will continue to be closely managed by insurance companies whose focus is, as Birenbaum said, a business one. If Barak Obama is elected, there may well be subsidized socialized health care, but it will be no more accessible to Americans than it is today. Managed care entities will continue to weigh the economic cost of the patient's diagnosis against the outcome of the DRG, and will make decisions about access to physicians - even if they are the providers the insured chooses for their self - and other health care services and treatments.

If John McCain is elected, based on his statements, Americans will experience little difference in the current health care system or availability of care, but will be taxed on their employer's contribution to their employee health care benefits.

What we hear from both candidates is that not much change will occur, but a shifting of the cost of health care to the American tax payers, with little change in access to care, or in the quality of the care that Americans will receive. It means, too, that managed care entities will continue to report profits to their stockholders (Altman, Stuart, Rheinhardt, Uwe, and Schactman, David, 1999, p. 331). In recent years, the managed care entities… READ MORE

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