Obviously, Hale's story lands more on the edges of the managed care continuum. Health care has evolved into a financial casino of winners and losers where quality does constant battle with a bottom-line culture that says money matters most. Whereas once clinical incompetence was the bane of medicine, the authors declare, today managed care has become the foremost threat to quality care. Certainly not everyone will agree. But Court and Smith make a strong case.
Health care is a very big business.
The worst inequities are easily apparent. Yet even many insured, better-off folks today are feeling the pinch of health care commercialism. Managed care means playing the margins and delivering profits by keeping premiums high and benefits low. As such, the system is flawed more by design than by any haphazard decisions of insurance bureaucrats or health system executives. According to Court and Smith, health care capitation is a big part of this flawed reality.