Defeating Evil? Try Managed Care

Countless Americans Put At Risk by Managed Care

One of the greatest perpetrators against mental illness in this country is the very thing relied upon for so many to get better. Managed Care is a system of financing and delivering health care to enrollees organized around managed care techniques and concepts. Designed en masse in the 1980s under the direction of Ronald Regan, it was intended to take the mostly not-for-profit health insurance organizations and model them more in the framework of for-profit organizations giving rise to many HMOs. To put this in the simplest of terms, managed care forced smaller amounts of time doctors spent with patients on a face-to-face basis, made it more difficult for people with serious health problems to see specialists, and introduced a concept, known in inpatient psychiatric settings as “Length of Stay”.

A standard was put in place, in many different areas of the health services industry, that determined, by illness, how long one should stay in the hospital (averages can be found here). Now, anyone who has ever known, worked with, or experienced mental illness themselves, knows that there is absolutely no standard by which to compare progress when it comes to certain disorders of mental illness (if not all).

At the hospital that I once worked, the length of stay, even for some of the most severe cases of suicide and depression, was 11 days. Eleven days, and if the average rose on a quarterly basis, insurance companies and managed care organization would begin threats and sometimes the motions of auditing the hospital, its doctors and its staff to see if it was “doing a proper job”. This scrutiny mounted and often times put pressure on administrators to discharge patients who were nowhere near ready. This often resulted in detrimental outcomes for the patients that often meant frequent re-admissions, acting out to prove to the companies of their dire state, or sometimes far worse.

At an epidemic rate, cost-of-care is literally killing thousands of Americans a year. Often times, the push for a patient to progress can be so overwhelming, they avoid hospital stays all together; wherein it should be a place utmost beneficial to them. Though the ubiquitous hold these companies have over many medical services often make those who should be the patient’s greatest advocate, their greatest impediment.

If this scenario were being played out on a smaller scale, in another line of work, it would be known as extortion. Though this extortion ends not at money, but at the very real outcome of life or death. Yet, very little, if anything at all is published or written about or made available to the public as a point of interest. Often times, its discussed in hospital corridors, back rooms, or relegated to the back pages of medical journals.

During this election season, please keep in mind as you hear greater talk of “privatized health insurance” in this country, that much of that definition revolves around the perpetuation of this most dangerous practice.