Challenging the systems on both sides. (managed care industry, the emphasis on profits, and the effect on the addictions field)

Challenging The Systems On Both Sides

After 18 years in the health care industry, with the last eleven devoted solely to alcoholism and chemical dependency, I have seen fads come and go. I have also seen trends develop which have become industry standards.

I can clearly recall a colleague of mine, who is very knowledgeable about the treatment business, assuring a group of executives in 1987 that their concerns about managed care were greatly exaggerated. His belief was that managed care cost containment would take hold in certain large companies on the West Coast and East Coast, but for heavily unionized companies and smaller companies, it would not become a real market factor.

His crystal ball must have been a bit foggy that day. He misread a developing trend as a passing fad.

Health care expenditures have become one of the top items on the agenda in corporate boardrooms as well as at the bargaining table. The dramatic increases experienced in health-related spending during the eighties have caused the nineties to be dubbed "the decade of cost containment." This orientation will be true in both public and private sectors of the economy.

The headlines in national and local newspapers declare that we are facing a national health care crisis. The industry journals and trade papers are on fire with reactions to the "onslaught of managed care" and the "woeful abuses heaped upon the treatment industry" by managed care companies. The metaphors of warfare and the language of combat are frequently employed in discussing the confrontations between treatment centers and managed care outfits. There is talk of being under fire, trench warfare, confronting the enemy, refusal to capitulate and even unconditional surrender.

Fears about managed care are reminiscent of the fears about communism in the 50's: "There's a cost manager under every bush, and all our problems can be blamed on them." I am interested in these symptoms of fear and I believe that there are some creative and balanced answers and approaches to the issues. We can live in the solution, not in the problem.

The very methods we use in treatment and the steps we encourage our patients to live by can be employed in our businesses to move out of the problem …