The health care consumer is happy to see the reduced premium and decreased out of pocket costs for services provided by the plan. What the patient does not see so clearly is the reduced service provided. Legislatures have gotten involved in such egregious limitations of care as drive through deliveries and the practice of sending mastectomy patients home the same day. But neither the patient nor the politician is in a position to see the thousands of other less obvious corners being cut in the name of cost control. The same time and attention cannot be provided by the physician, because the system is so dominated by a drive towards greater productivity.
Greater productivity means less time and energy per unit of production.
They have been accepting of the new health care organization because they have had relatively little interaction with it, except for simple routine care. All they see, so far, is the reduced out of pocket cost. Managed care can provide this with great efficiency. However, when a problem becomes more subtle or complex, there is tremendous pressure from managed health care plans on their physicians to limit testing, referrals and treatment.