
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, January 23, 1995                   TAG: 9501260027
SECTION: EDITORIAL                    PAGE: A-4   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

MANAGED FEAR

"LIMITED choice" was one of the fears raised by opponents of health-care reform during the last session of Congress, and that fear was used effectively to muddy the debate and undermine the public's resolve for change.

Now a new majority in Congress - whose passive resistance in the last session of Congress helped kill reform - enjoys broad public support, and is expected to identify solutions to the nation's problems rather than the problems with any proposed solutions.

One of the biggest problems they, and the nation, need still to work out is how to limit the soaring cost of Medicare. The program's hospital trust fund is expected to go broke in only five years. The remedy being eyed now by congressional Republicans is . . . managed care.

That should sound familiar.

Managed care is essentially a negotiated deal guaranteeing volume business to health-care providers in return for discount prices. During last year's health-care debate, it became synonymous with "limited choice," and freedom-loving Americans wailed. They wouldn't be able to choose any doctor they wanted. They wouldn't be able to go directly to a specialist.

And they were right; most of them wouldn't - not without paying more of the tab themselves, anyway. But the outrage was misplaced.

The marketplace already had been shifting - stampeding, actually - to managed care. It may be less than what some people want, but it is what most companies can afford. And it makes sense. Ninety-five percent of insured, working-age Americans are now in some form of managed care.

Advocates for the elderly are crying foul, remembering elected officials' pre-election opposition to limited choice. Given the trend to managed care in the private insurance industry, some members of Congress may be accused of - - this will come as a shock - hypocrisy and political expediency for feeding fears about "choice" during last year's debate.

But Medicare recipients enjoying tax-supported coverage should not expect to avoid cost-saving measures that are widespread in the private sector and that don't appear, despite complaints about inconvenience, to have a major impact on quality of care.

by CNB