The Canadian Record (Canadian, Tex.), Vol. 108, No. 3, Ed. 1 Thursday, January 15, 1998 Page: 2 of 28
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THURSDAY 15 IANUARY 1998
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opinion
page
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Managing managed care
Reprinted from the Washington Post National Weekly Edition
A FEW YEARS AGO, managed care and its
Mmcousin, managed competition, were just about
everyone’s favorite means of achieving health care
cost containment. The promise was that they could
cut the cost of health care without reducing quality.
The evidence wTas the dramatic success they ap-
peared to be having in flattening private-sector costs.
Their particular virtue, not least to the politicians,
was that the thing could be done without government
intervention, meaning that the politicians weren’t the
ones who had to say no to anyone. For a fee, the
private cost police would do it for them.
The bloom is now off that always improbable rose,
74e (2<vtaxUa*t
RECORD
USPS 087-960
P.O. Box 898, Canadian (Hemphill) Texas 79014
Fax #: (806)323-5738
BEN EZZELL Editor & Publisher 1948-1993
NANCY EZZELL Editor & Publisher
LAURIE EZZELL BROWN
Co-Editor & Photographer
e-mail address: lrbrown@well.com
GRETA BASS Advertising Manager
STAFF:
Leslie Fry, Kim McKinney,
Mary Smithee, Gabriel Brown
Periodicals postage paid at the Post Office in
Canadian. Texas. Published each Thursday after-
noon in Canadian by Nancy M. Ezzell.
POSTMASTER: Send address changes to
The Canadian Record, Box 898, Canadian, TX 79014
SUBSCRIPTION RATES:
$20/Year in Hemphill County
$2S/Year in adjoining counties
$30/Year elsewhere
if ever it was on. Doctors and other providers were
the earliest to rebel. The care companies amassed
great buying power and used it to limit the accus-
tomed authority of the sellers of care to do and charge
what they pleased. Patients — not all, but enough —
began to complain as well, as they found that the
companies in the name of cutting costs were limiting
the array of available care. Now' a third collision may
be in the offing from the opposite direction, between
the companies and their principal clients, the busi-
nesses and governmental bodies that are the main
payers for care. The managed care companies them-
selves are facing a squeeze. Their revenues won’t
cover the care they’ve promised; their balance sheets
are suffering, and their premiums have started back
up again, a threat to the very virtue on the basis of
which they sell their services.
The problem is partly that much of their success
in the past few’ years has been illusory. They have,
indeed, created some genuine efficiencies and sav-
ings in health care. But many of these have been of
the one-time-only variety. The figures look good in
the years in which the changes are being made; then
the underlying costs resume the upw’ard march the
new practices had helped to mask.
The companies also produced a lot of up-front
savings by forcing shifts in costs. To keep from losing
business, a hospital w’ould agree to charge a large
managed care company less, they try to recoup the
loss by charging weaker buyers more. There have
also been some shifts of costs to patients, in the form
of higher deductibles, co-payments and the like. The
principal payer’s costs go down. It thinks money has
been saved, but in fact the cost is simply being paid
another way. There has been a benefit cut, not a
savings.
The companies also did a fair amount of low-ball-
ing early on, keeping premiums artificially low to
increase market share. But that can go on only so
long. In Medicare now, Congress has cut premiums
as part of its effort to balance the budget. Some
companies are responding by reducing benefits, such
Continued on Page 4
IF YOU’VE EVER SPUN YOUR WHEELS in the loose gravel of some
government representative’s voice mail, or thought seditious thoughts
while negotiating the tangled network of options and extensions in the
course of a telephone call to “the proper state agency,” State Comp-
troller John Sharp’s survey is for you. If you’ve ever been put on hold
for five minutes or more by some bored bureaucrat who’s forgotten that
the word “taxpayer” accurately translates into “boss,” this survey is for
you.
If you’ve ever been passed along from one Texas Capitol Complex
office to another—only to wind up at the end of the day right back where
you started—by golly, Sharp’s survey is for you. And if it sounds like I
have spent some time of my owti doing the Capitol Complex Shuffle
w’hile singing the 5-1-2 Blues, that is precisely right.
I’m certain there are ways to coax good customer service from our
State Government. If it w'ould be helpful, 1 can tell you some terrific
ways not to...’cause I’ve tried ‘em all. Why, I’ve even cadged a Capitol
Complex Telephone Directory from a bureaucrat of my acquaintance,
and forked over another $27.50 per annum for my owrn copy of the Texas
State Directory, which bills itself as “The Comprehensive Guide to the
Decision-Makers in Texas Government.”
Problem is, those folks are so busy making decisions, they’ve plum
forgot to pick up their telephones. Why, I’m not even sure phones in the
5-1-2 area code actually ring.
Of course, a concerned citizen can ahvays straddle an airplane seat
and, in just a matter of hours, set their own two tired feet down on Austin
soil. There is that small matter of the $300-plus dollars it costs for a
ticket to the capitol, and the four-hour round-trip travel time required
just to get to the airport...but a packet of honey-roasted goobers and a
$4 beverage will have you humming “Texas, Our Texas” in no time.
The survey to which I refer was published in the January 1st edition
of The Record, and is also available at the Comptroller’s website located
at ttp://www.window'.state.tx.us/service.html. It is entitled “How well
does Texas State Government serve you?” and offers this suggestive
subtitle: The Good, The Bad and The Ugly.
It’s true that Mr. Sharp has designs on higher office, w'hich might
indicate some ulterior motive to his quest for feedback from the citi-
zenry. But let’s set aside, for the moment, any such cynical suspicions,
and recognize an opportunity to do a little truth-telling about how
telephones and such work up here in the 8-0-6 part of the state.
Mr. Sharp’s survey asks us—among other things—to relate our best
and worst customer sendee experience with a Texas state agency. Now
that should make for some lively truth-telling. So what do you say? Let’s
help him out. Let’s rate the state’s telephone assistance, complaint
processes, respect for customers’ needs and time waiting for serv-
ices/lines. Surely somewhere between “excellent” and “bad” we can
pinpoint an accurate descriptive term.
I’d be happy to make some extra copies of Mr. Sharp’s survey
available to our readers, and will even throw in a few sheets of recycled
paper to provide room for your additional suggestions and comments.
While I’m filling out my copy of that survey, I might just as well
sharpen my pen and give some attention to another one which just hit
the desk. This one comes from the folks at the National Newspaper
Association, and asks publishers to share information about poor news-
paper deliver}' and other postal complaints.
Since conducting our own informal survey of subscribers, we’ve
compiled quite a file of what I fondly refer to as USPS B.S. We’ve filed
countless “Periodical Watch Forms” for subscribers whose newspaper
delivery can only be described as abysmal. We’ve bucked the postal
order and re-arranged out mail routes, bypassing some bureaucrat’s
greedy and inefficient little postal fiefdom in the North Dallas sector.
We ve read your letters and e-mail, noted your complaints, and regis-
tered them with the powers that be, and a few that only wanna be.
We’ve even scratched our heads and shuffled our feet...which seems
to have been just about as effective as anything else we’ve tried. We’ve
apologized to you, and we’ll do so again. The good news is: We’re not
the only ones. The bad news is: We’re not the only ones.
So one more time, I m going to ask all of our readers who have
experienced unreasonable delays in receiving your weekly copy of The
Record to give us a call at 806-323-6461, send us an e-mail message at
lrbrown(« well.com, or—if you appreciate irony and enjoy taking
risks—drop us a note at P.O. Box 898, Canadian, TX 79014. Tell us if
your newspaper delivery has improved or gotten worse in the last year.
Field Notes continued on Page 3
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Ezzell, Nancy & Brown, Laurie Ezzell. The Canadian Record (Canadian, Tex.), Vol. 108, No. 3, Ed. 1 Thursday, January 15, 1998, newspaper, January 15, 1998; Canadian, Texas. (https://texashistory.unt.edu/ark:/67531/metapth520700/m1/2/: accessed June 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting Hemphill County Library.