The End of Managed Care
California Medical Association Fifth Annual Leadership Academy
La Quinta, CA
November 16-18, 2001
James C. Robinson, PhD, MPH, Professor of Health Economics, UC Berkeley:
"I think that we are heading into a more consumer driven system... Why? Because the other four candidates - government, employer, insurer, and physician organization - have all bailed... In the end, it is going to be the consumer who is going to have to make the decisions of who gets what and how much am I going to pay? Insurance is going to have a role in that, but clearly we're going to be placing a lot of this on the consumer, and that's going to be problematic. Some consumers are great decision makers. Some consumers have disposable income. Others are lousy decision makers. Others are in a coma. You know, they don't fit the profile of a shopper that well. This is no one's idea of a perfect system. There is no happy ending to this story."
Question from audience: "... I'm interested to find out what your theory is on medical savings accounts where the individual takes responsibility for their own health care."
Prof. Robinson: "What about MSAs? More broadly, the notion of the consumer paying more out of pocket. I do believe that it is going to be a major part of our system going forward. Deductibles are rising like crazy. The big new Aetna product - the high deductible MSA-type product... This is happening very, very fast. This is considered part of consumerism. I think that consumers are going to hate consumerism... I think that deductibles can be really good. All of us should be more cost conscious. But the problem is that they discriminate against the poor, against the sick. Aside from that, they're great."
Comment: Our next great experiment in health care funding is consumerism, and consumers are going to hate it. And yet we will continue to discriminate against the poor and sick. Do we really have to complete this experiment which we already know is doomed to fail? Instead, can't we just go ahead now and introduce equity into health care by adopting a publicly administered program of universal health insurance? If, in advance, we agree to maintain our current generous level of funding, patients would emphatically support our system. And, after all, isn't health care really about patients?