Managed care wins if doctors unionize. If the AMA union holds, then its doctors are unionized laborers who have vowed not to strike. The costs managed care incurs while fighting them are passed on to employers, employees, and health plan members. Certainly large employers, whose costs have been driven down, and who wanted managed care in the first place. The government, of course.
Patients dislike managed care just as much as they dislike government.
And patients are getting more fed up as the millennium approaches. Managed care has made money by reducing the fees it pays to doctors, dentists, hospitals, pharmacies, and home health organizations. Doctors have little data and less expertise in these negotiations, and have consistently come out badly. As managed care has gained power, the number of managed care companies in urban and suburban areas has declined. In Albuquerque and Minneapolis, for example, there are only a few large managed care companies.