Managed Care Has Progressed

My remarks in San Diego were not specifically focused on managed care medical directors as Dr. Haberman implies. I know quite a few of them and count them as friends and colleagues. But in the context of the early 1990s, when managed care companies, at the behest of the major third-party payers, cut the costs of care, there was an unprecedented morale crisis for our field. Clinical decision making was compromised in the effort to contain costs.

We can argue about whether that was necessary then, but the reaction from the profession and from patients and families led to significant changes in managed care practices. In the last five years, we have seen more interest in the field as practice once again is primarily determined by the treating, not the reviewing, physician. It is to the credit of the current generation of medical directors in managed care that the process of care and costs is much more collaborative than it once was, but from time to time there are conflict and sensitivity. I also believe health care inflation is real, and the administrative costs excessive in our overly managed system. I have devoted much of my research and work to finding ways of improving access to effective and efficient care for all Americans.

Personal attacks are not helpful as we need to understand each other and be part of the solution, not the problem. APA provides a forum for debate and discussion.