Clinton's Cure: Managed Care Comes to Medicare

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It was probably only a matter of time before the joys of managed care — like copayments and "preferred providers" — infiltrated government health plans. And that's what is being proposed by the Clinton administration, which on Monday issued a cost-cutting plan to shore up the troubled Medicare system. The plan, which has already divided congressional Democrats, involves distributing a list of government-approved hospitals and doctors to each Medicare recipient. If a patient chooses to use those facilities, both the patient and the government would pay less for the treatment.

The same complaints about managed care are being made about this revised Medicare — that doctors, faced with less income on each patient, will have to squeeze in more clients, thus lowering the standard of care. And this debate won’t be limited to AMA meetings — patients’ rights groups are bound to protest Clinton’s plan. After all, when it’s time for an annual physical or a specialized procedure, who wants to see a doctor who’s speeding patients through a slapdash exam in order to make ends meet? Of course, the same problems of ever-rising costs that have led to managed care also face the 34-year-old Medicare system, and proponents of the new plan say that some sort of cost control is required if the system is not to collapse. And with the United States just about the only country that doesn't in some way ration its health care, such moves appear bound to happen sooner rather than later.