Fighting Over the Shrinking Pie

Zingale: Unfortunately, we’ve been spending a lot of time and resources fighting over how we divide a shrinking pie in the health care delivery system. I am interested in moving beyond this and returning to the root principle of managed health care, which I believe offers the key. Managed care was founded on the principle of early investment in preventive health to keep more people healthy for a longer period of time, thereby preserving our precious health care dollars for people when they are really sick. Under that model there is no excuse for not providing optimal care when people really need it. We’ve strayed from this in a number of troubling and complex ways, and I believe that only by returning to that principle will we be able to raise ourselves out of this bickering over who pays how much for what.
Healthline: Does this assume that preventive care is actually going to save money, and not merely allow for patients to develop more expensive diseases down the road, as some health care economists have argued?
Zingale: Economists who argue that preventive care is not cost effective are wrong. There is a mountain of evidence proving that relatively low-cost, early preventive interventions save health care dollars, save lives, and prevent human suffering. Anyone who quarrels with that is at odds with the goals of this new department. I believe there is enough agreement and understanding among the principle players用roviders, consumers, and plans葉o move ahead on this.
Healthline: It certainly makes sense to take advantage of the “managed” part of managed care: the ability of HMOs to track patients, remind them what to do to take care of themselves. But how can you do this in an environment with such turnover用atients being dropped and switched and not knowing what is going to happen with their plan from one year to the next?
Zingale: You’ve identified one of the current obstacles to prevention playing the role in managed care that it shoulda: the transitory nature of today’s enrollees. From a purely economic point of view, a health plan can make a decision that it isn’t worth the investment in keeping an enrollee healthy in the long term because that enrollee is likely to have moved on and the cost savings won’t be realized.

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