Part III: The Noise of Silence/Health Care

Managed health care, the model for health care before Obamacare, emerged in the 1990s as an attempt to answer the problem of excessive costs in the U.S. healthcare system.  The hope was that by treating the caring profession as a business rather than a service, bottom-line discipline would bring run-away costs under control.  The changes in health care delivery are exemplified by the health insurance industry, which created a new method of delivering health care.

A wide range of groups emerged to "mange" care, that is, managed care organizations (MCOs), health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service groups (POSs), independent practice associations (IPAs), insurance reviewers, hospital administrators, institutional managers, and the purchasers of groups needing care who run the health care corporations.  The difference between HMOs and PSOs (provider-sponsored organizations) is ownership.  HMOs are usually owned by insurance companies, whiles PSOs are owned directly by doctors and hospitals.  Essentially, the "1 percent" of the health care industry in our society who prefer the business medical model as oppose to the new potential accountable care organizations (ACOs) resulting from the Affordable Care Act (the "99 percent" Obamacare).

Whatever the type, managed care functions as individual, profit-driven corporations whose product is medical care.  The vocabulary used by these organizations reflects their corporate image:  the "consumer" (formerly the patient), the "provider" (the physician and other health care professionals), the "insurer" (the reimburser for any care), the "buyer" of health services (most often the large employer organizations).  A certain dollar amount is negotiated for health care for a certain number of patients whether the care is given or not; the provider shares with the insurer any financial risk for the actual costs of care.  And despite the observation by some health industry analysts that managed care heralded an alternative to the medical model, it fits squarely with that model.

In this new Health Reform environment, language can be a barrier in describing the underserved population in the U.S. healthcare system.  A person-centered approach will help to reduce health disparities among people who are classified as low-income, minorities and lack access to adequate quality health care.  Merck pharmaceutical with its MerckEngage .com commercial best describes the person-centered model:  The people in the commercial provided the following:
..."I am not a statistic; I am not a target-market; I am not a demographic, or data, or a patient.  I am a person; a butcher; a mom; a daughter; a teacher.....I am a human being who happens to have type II diabetes.  The Affordable Care Act allows us to be fully human, if "We the People" decide to make health care available to all the citizens in the United States.