The People vs. Managed Care

Patients, physicians and the larger community were not prepared for them. We had not anticipated that they would wield enough financial power to sway many patients from their physicians, would become the brokers of health care (and often of death), and would take the role of arbiters in the distribution of health resources.

In many respects, physicians were taken prisoners by health maintenance organizations and others, and treated as powerless line workers.

Counterbalancing forces emerged from the beginning. Even in the early 1980s, when the invaders were starting to press ahead, physicians and patients were organizing to fight back.

We physicians and patients had to prepare for war because the insurers and their representatives came to challenge our decisions, our right to explore a proper diagnosis, our determination to propose the best treatments, and even worse, our freedom to communicate with each other.

Our presentation here explores the history of the invasion. It also presents the reasons that led us to devote years to fighting the invaders, the phases of our struggle, the factors that framed the present, and our vision of the future

The history takes us back to the events that preceded President Nixon's fateful decision to give the green light to Health Maintenance Organizations.

The narrative of our campaign against managed care abuses reveals our approach to develop a powerful coalition of physicians and patients to fight for our rights.

Our analysis of the present and the future comes from our assessment that the American public has become aware of the problem and has joined our mighty struggle.

Our field of psychiatry is the medical discipline most beleaguered by the invading entrepreneurs. This is why our story may have value for every person who cares about the future of medical care in America.