This presupposes a number of things, not the least of which is that the insurance industry will allow this to happen. And this choice ignores the fact that Medicare and Medicaid are already existing single-payer systems that the government seems all too anxious to terminate in favor of the highly regulated managed care model. Therefore, expecting to be rescued by the cavalry is not the best way to plan for the future. To do something effective, then, we have to think of ourselves like the Japanese. After years of stonewalling change, they peered down the barrels of Perry's cannon and got the message.
Real change is required in psychiatry's philosophy and outlook.
This means being realistic and ridding ourselves of unproductive fantasizing. It means taking health care economics seriously and viewing the competition realistically. Demonizing the executives of MCOs does not represent a realistic strategy. As practicing psychiatrists, we must realize that we have all the responsibility and hold all the risks in patient care. We have ethical obligations to those who come to us, no matter what their health plan.