Managed Careless

Being sick has changed – not because of new viruses, incredible scientific discoveries, marvelous new techniques or whatever, but because powerful corporate interests are now pulling the strings of the medical world.  This change has been astonishingly fast and invisible.  Since most of us will get sick before we die, most of us are affected by this change.

If we are to make our way in this brave new world, there is new language to learn. Lawyers and MBAs are now running things and crusty old terms have been replaced with snappy new ones.  For example, “medicine” is now “health care,” doctors, psychologists, nurses, etc. are now “health care providers,” and even you are no longer a “patient” but are now a “health care consumer.”  This may make you feel a little better already since being a “patient” is supposed to have the connotation of being sick, passive and – well – patient.  On the other hand “consumer” suggests that we are now healthy, aggressive treatment-shoppers.

However, as with things in this revolution driven by marketing departments, the terms tend to spin in the direction away from the truth.  “Patients” used to be able to exercise lots of choice about their treatment (where to seek it, from whom, how aggressively, etc.) whereas “consumers” are pretty dumb and need lots of direction from their Treatment Managers about all those matters.

As we know, medical treatment has become more expensive (due mainly to high tech procedures and the greatly extended process of dying).  Thus, employers have had to pay more to insurers, who pay more to the treaters.  In the vacuum created by the congressional trashing of National Health Insurance, a new force entered in: a revised insurance industry with muscles that would not simply pay for treatment but control it.

More new terms.  An especially important one is Managed Care.  It is confusing, until we discover that for the sake of simplicity it really a shortened form of the actual term.  Managed Careless.  This is a system whereby care is managed in order to make sure that there is less of it.  This saves money and makes money, and the shareholders of the Managed Careless groups appreciate that.  A secondary meaning of the term is that treatment, when given, is best given rather carelessly.  Too much time spent talking with patients, protecting the confidentiality of their records, letting them see treaters they find especially effective, etc. all cost money.

Another important term is HMO, or Health Maintenance Organization.  This is also confusing because it too is a shortened version of the whole thing: HMOTO or Health Maintenance of The Organization.  Many ingenious ways have been developed to maintain the health of the organization and keep its green life’s blood pumping vigorously.  One means is by restricting who can give care.  “Patients” used to choose their own doctors (driven by such trivia as their perception of competence. liking, trust, familiarity, previous good care). “Consumers” are herded into a little stable of highly domesticated providers who are paid each month on the condition that they will not do too much.  Most groups use a process called “capitation” (this may be a shortened form of “decapitation” although so far, recalcitrant sick people are not beheaded).

We will all learn more as this bold social experiment progresses.  The ones who seem to be most strongly affected so far are those least in a position to protest about it: mainly those in need of mental health treatment.  There are several big new Managed Careless groups which exist solely to drastically reduce the amount of psychotherapy in the world.

Next most affected are those who are hospitalized (tried to stay in the hospital after an operation lately?) and those who have chronic illnesses.  If Congress gets it way, the poor (Medicaid) and the elderly (Medicare) will soon be sharply targeted.  When the need to reduce medical costs combines with the ancient urge to make big profits, who will be hit next?  It will be us.