Monday, March 19, 2007

The Mismanagement of Managed Health Care

Today's Reuters release concerning the Commonwealth Fund report on health insurance makes for a useful supplement to the HBO Addiction Project. One of the most painful parts of the Addiction documentary was the way in which it addressed addiction treatment in theory and practice. The theory was good news, dealing with the ways in which addiction can now be treated through both pharmacological and human interventions. The reason the practice was bad news was because the primary message was that such interventions are inadequately covered (if covered at all) by just about all managed health care systems, meaning that the people most likely to benefit from the theoretical results are least likely to have the practical means to do so. Dickens knew how to write about this kind of phenomenon. This is a case, however, where one cannot invoke the "nobody's fault" gambit from Little Dorrit when the more suitable characterization would probably be Ebenezer Scrooge's reduce-the-surplus-population argument.

This is the context in which Reuters released today's report on managed health care:

At least two of the health care proposals being presented to Congress would cover all or nearly all of the Americans who lack health insurance, and many would lower spending, too, according to an independent report released on Monday.

Many of the plans would do more to cover uninsured Americans and lower costs than President George W. Bush's proposals, said the nonprofit Commonwealth Fund, which studies health care issues.

Is this a matter of economic ignorance or just pure callousness? One possibility is that it involves an ignorance more social than economic that happens to be part of the family context. One has to recall Barbara Bush at the Superdome, captured for posterity in Spike Lee's When the Levees Broke, suggesting that conditions there (which had deteriorated pretty far by the time the elder Bushes put in their appearance) might be better than those of the evacuees' homes that had been destroyed by Katrina. What makes the rich different is not that they have more money (as the old Hemingway-Fitzgerald joke goes) but that their money impedes their perception of any world-view other than that of their own class. This comes precious close to old Scrooge where addiction is concerned: Better to "reduce the surplus population" of addicts than to support a health care system that would see to their recovery. Fortunately, there are now Democrats in both the House (Pete Stark) and Senate (Ron Wyden) more interested in seeing such unfortunates treated as human beings and still doing it in a cost-effective manner. They deserve our support.

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