Managed Competition?....
...Or just another Medical Monopoly.

By Robert Braile, D.C.

To help fight the spiraling costs of health care, one of the newest buzz words being thrown around is "Managed Competition". The proponents of this type of thinking believe that insurance-type conglomerations, with their own list of physicians, can compete against each other and therefore bring down the cost of health care. The reasoning is that open "free competition" between individual doctors in the health care system has not worked in the past, and therefore this new "managed" system should help control health care costs.

Unfortunately, this newer system is doomed to failure for the same reasons that our current system is out of control. The basic problem is that we have never really had any type of competition in our healthcare system, and the new Managed Care approach solidifies this even more. In business, the major factor that keeps prices of goods and services under control is competition. If General Motors were the only car company, the prices of cars would be much higher than present, because GM would not have to worry about losing business to Ford or the Japanese auto makers. If New York City only had one restaurant, how much would a meal cost? It is for this reason that we have antitrust laws to protect us against business monopolies. However these laws have never applied to health care.

At present we live under a "Medical Monopoly". If you are sick, in pain, or have a health problem of any kind, you are led to believe that the only choice you really have is to see a medical doctor. You are swayed in this direction because for decades the government has pumped billions of dollars into the medical community and excluded all other forms of health care. You are probably also swayed in the medical direction because your insurance or Medicare or Medicaid pays better benefits if you go this route. In reality most people will choose the type of doctor that their insurance pays for.

If the government paid each consumer 80% of the cost of purchasing a new car from GM, who would buy a car from Chrysler or Toyota? And after a while how much would that GM car cost? If in addition to this, if the government spent billions on research to help GM, spent millions to subsidize GM employee training schools, and millions on public education about the benefits of GM cars, how many other car companies would survive?

This is exactly the type of system we have lived under over the past few decades. This is the type of system that has fostered the increases in medical expenses until our nation now spends 14% of our gross national product on medical care. This is the same type of system "Managed Competition" now offers. With this system, we are, and will continue to be under a Medical Monopoly.

If we are serious about reforming our health care system, and are interested in reducing costs, we must make meaningful changes in the system itself. Refinancing the way we pay for our current health care system will not solve our problems. However, it is only refinancing and limiting choice of doctor, that Managed Competition really offers.

The solution to fixing our health care problems comes with promoting competition between the different types of health professions and the doctors themselves. At present there are a wide variety of other health professions for people to choose for their health care needs. These are unjustly called "alternative health care" professionals. In reality they are simply doctors and health care workers with a different approach to health then the Medical profession. This certainly does not make their approach any less valid or important. It just makes them different, and therefore a minority among the health care world.

Unfortunately, many or most of the services performed by these professional are not being paid for by government programs or the proposed new managed competition systems. Professions such as chiropractic, nutrition, acupuncture, homeopathy, massage, exercise, and counseling, to name a few have been virtually passed over when it comes to government funding of research and education, as compared to the medical profession. Recent surveys show more people choosing these alternative health care professions. And yet the cost for these services remains a very small fraction of the amount we spend on medical care.

If we want to bring down the cost of health care, we must realize that there is more than one way for people to achieve and maintain health. We must stop subsidizing only one form of health care to the exclusion of all others. We must give the public a chance to fairly choose which doctor they want to see, and for what type of care, without huge financial barriers that force patients into one medical choice. If we want competition, it must be between the health care providers, of all types, and not just among the insurance companies and the managed competition groups, as is being proposed today.

While the rest of the world is striving toward freedom and democracy, we need to have more faith in our American free enterprise system. We also need more faith in the health care consumer, who when given fair choices along with the facts, will make the right decisions.