The Golden Pot of Managed Care
There is a lot of talk about how managed care is the wave of health care. What is an Managed Care? Managed Care is what Bubbas experience when they huddle together and, as a group, run around demand health care services at Bubba rates paid for by their employer or government... Below is a review of the future Managed Care. BTW, this article was originally written in 1993 before medical marijuana legalization started to move.
Meet Bubba... he works at Bob's Widget. Bob's Widget makes medical widgets. Bob currently pays for Bubba's health care premiums through Quality Medical Plan (QMP) paying $75 a month for a plan that, while modest, provides Bubba the basics. Bubba sees Dr. Welby at Welby's family Clinic. Bubba doesn't realize it, but he already belongs to a voluntary managed care alliance.
Bubba likes the fuzzy warm notion of employer based managed care and thinks everyone should get this kind of carejoi. So HilBil waves his majestic hand and lo and behold, every gets coverage! What a deal! Of course Bubba nows has maternity benefits which, God knows that Bubba and his wife will surely need since he has a vasectomy.
But then there is Bubba's old buddy Bobo. Bobo always lives a little on the wild side. He has at least four known children (Bobos booboos) with a four different mothers, smokes a little crack now and then, which he usually mellows with a few drags from a cig. One of Bobo's kids has a cleft palate from his mother taking drugs while pregnant. Bobo is too confused to ever hold down a job or a wife, so the whole group, Bobo, his four ex-girl friends and kids live on welfare or disability of some sort.
Along comes a welfare worker making the rounds with an application to join the QMP alliance. Just in time. Bobo is on his way out the door to the Aid Car with chest pains...
Bubba visits Bobo in the hospital. Bobo is sitting up in bed and says, "Wow that was a close one, do you have a light? These nurses don't have one and say I shouldn't smoke but I need one. Be a good buddy Bubba."
On the way home Bubba thinks 'Boy, Bobo sure was lucky he is getting such good care. This managed care is great.' On his was home he cashes his pay check. Hey, there is another $50 bucks going to pay for health care premiums. Bubba has to cut back on his HBO subscription.
Bubba goes to work the next day. Bob tells Bubba that things are getting slow. Hospitals are getting slow in payments on the Widgets. Bubba is going to have his hours cut in half. He has to cancel cable altogether. Bobo has it as part of his low income housing and welfare stuff (subsidized by selling a few joints on the side). Bubba can always go visit his good old buddy Bobo.
Bubba starts looking for another job. Mary's Widget isn't hiring either. He is just stuck. His premium expenses are at least being subsidized. He hears some 'garbage' from both Bob and Mary that they are struggling to make ends meet with all of these increased health care costs, the new tax rates coupled with hospitals lack of money to buy new Widgets. Bob tells Bubba that the managed care alliances are squeezing the hospitals budgets so tight that they can barely afford to pay for the widgets Bob has already delivered. Bob is having to cut his Widget research department to half the size due to a slower market for widgets and future widgets.
Bubba goes to visit his friend Bobo who is at back at home. Bobo offers Bubba some grass. Bubba hasn't enhaled in years, but what the heck. Bobo tells Bubba that President is very dismayed about the downturn in the economy and is offering training classes for part time workers and the unemployed. "Boy those liberals sure have feeling for us Bubbas", thinks Bubba. "That Rush guy and his conservatives have it all wrong".
Bubba gets retrained as a janitor. He finds a job working at the city cleaning the floors of the Department of MESS (Mandated Employer Subsidized Socialism). The MESS's offices are in a huge new building with marble floors that replaced an abandoned downtown department store (that also had marble floors). Just think of all the jobs were created making that new building!
His old health plan is not carried by the Dept of MESS. One of three plans has Dr. Welby as a provider so he signs up for that one. He calls Dr. Welby's for an appointment for his yearly physical.
The receptionist answers the phone, 'Quality Family Medical Clinic'. She tells Bubba that Quality bought out Welby's practice last year as a part of restructuring. Dr. Welby has been transferred to a new clinic on the other side of town. Bubba knows it is time for his Flex-Sig, where the doctor looks up his colon for any growths. He isn't so sure about having Dr. New do the procedure as Dr. New is just that... new.
Bubba makes an appointment with the clinic Dr Welby is assigned to. He shows up with his new trusty Health Card. The waiting room is standing room only. Good thing he doesn't have to fill out those forms. Only thing, he never had to at Welby's. He and his family had been going there for years and hardly ever had to wait either. Oh well...
He sees an old friend of Bobo's with her three kids. She has a card, too. She tells Bubba that he needs to get with the program. The only way you can get seen on time is to show up two hours early, just like you do for welfare appointments. Come by after you get off work and we could fool around.' She is getting her "free" AIDS check today. Bubba politely declines.
The nurse finally calls Bubba's name. On the way back to the exam room, he sees a Widget sitting in the corner. Looks unused. Dr. Welby comes in. 'Oh, the Flex-Sig will have to wait a year. Your new plan doesn't cover it as often as your old one.' Bubba asks Dr. Welby about the Widget. Marcus tells Bubba that they don't have the staffing and education funds to teach anyone how to use it. Nice machine though. He used to have one in his old office. Hard to get parts now.
Later next year Bubba notices a pain in his lower left side. He goes to the clinic and waits again. On the way Bubba notices a 'for sale' sign on Bob's Widget. They find a growth in Bubba's colon. He is put on a waiting list for surgery.
After three agonizing months of waiting his surgery is on the top of the list. But it is Alliance/Provider negotiation time. The Alliance wants to cut provider fees five percent, the doctors want a raise to cover the increase in taxes that the government just passed. The surgeon has decided to take an extended vacation until this gets settled. She is going to be golfing with Dr. Welby who has retired...
Bubba survives the surgery, but they weren't sure if they got it all. At least he has an opportunity to work with Bubba Jr who just got out of college with a degree in medical engineering. Bubba Jr got a job as a janitor in community service. Bobo wants to come over for a visit and share some great new 'stuff' he got from detox.
Bubba says no, he has to work on his taxes. Seems like they are going up again -- premiums are higher too. Bubba ponders, how did this all happen anyway? Oh, why not call Bobo back? Bubba remembers hearing the stuff (pot) is good for chemotherapy naseua. It is now a covered medication under his managed care's prescription benefit. Maybe Bubba could share some of his stash with Bobos.
Oh that warm and fuzzy feeling... Bubba recalls something about how managed care alliances wanted a cost effective nausea medication and there wasn't any money for new research in the tight managed care budget.
OK, so I have pushed the envelop of managed care a bit. As amusing as it may seem, this is perhaps the leading edge of managed care. Managed Care -- pro and con? To me, it mostly seems like a PRO CON job. Managed Care may have a place in health care as a marketplace option in a vibrant individually driven health care social marketplace, but they should not be relied upon as the centerpiece of reforming the health care system. There is too much government, too much carrier, too much interference in the doctor-patient relationship.