In "Health Against Wealth," George Anders, senior special writer for the Wall Street Journal and part of a team that won the Pulitzer Prize in 1996, closely examines the managed-health industry.
Through a sweeping examination, he explores many opposing facets of the health care field. The overwhelming focus of the work is on the weaknesses of the system, but at times this focus tends to ignore important facts and questions.
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Anders cites an example of when Chrysler provided employees a generous allowance for psychiatric care and health costs jumped 500 percent.
He then continues with a brief look at the first appearance of managed care organizations and different problems associated with their emergence.
When the work finally begins examining the quality aspect of it, he solely takes a negative view of managed care. One of the principles of managed care is to turn primary care physicians into gatekeepers.
They are meant to decide who should have access to specialists and more expensive procedures. Anders centers upon the negative aspects of this role, rather than exploring both its positive and negative impacts equally.
The work continues to examine different areas of patient care. It centers on heart problems, breast cancer, mental health, emergency care, mental health, geriatrics and the poor. Although this is a broad sampling of the health care industry, the analysis is still myopic.
In each of these cases, Anders again centers solely upon the negative aspects, leaving many questions unanswered. He never addresses how managed care compares overall with the traditional system.
He also doesn't address the frequency with which the problems he mentions occur. Most importantly, he never states whether the HMOs he examines are representative of the industry on the whole. Without comparison, the reader has no way to tell whether his criticisms are justified or only nit-picking.
The remainder of the work examines the industry as a whole. In one fascinating analysis, Anders explains the political lobbying tactics of managed care.
Though highly critical of its methods, Anders doesn't differentiate managed care from any other special interest group. In fact, this lack of perspective is representative of the main problem with "Health Against Wealth." Anders doesn't compare managed care with anything, and without the comparison, there is no way to tell whether they are unscrupulous or not.
The work continues with some criticisms of the gateway system as well as the overall quality of managed care. In both areas, the analysis falls to problems similar to those found earlier in the work.
What is impressive about "Health Against Wealth" is that it not only points to problems within the system but also provides some solutions, many of which are sound.
Anders mentions many different ways by which doctors, regulators and consumers can improve the quality of their health care as individual groups. These solutions require some work, but seem within the grasp of the laziest member of a managed care group.
Other solutions sound a bit too simplistic. Many require managed care directors, doctors and regulators to form policy decisions together. As the work points out, however, no two of the groups are able to get along and compromise very often. In fact, such ideas sound more like wishful thinking than sound advice.
"Health Against Wealth" illuminates many different facets of managed care. An otherwise excellent investigation is ruined, however, by the author's preconceived ideas. The examples and analysis Anders offers are often incomplete. He appears to be out to prove that managed care is a problem and, in that position, ignores data that might prove otherwise.
- Mahesh Joshi
04-20-98
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