Vertical Restraints and Powerful Health Insurers: Exclusionary Conduct Masquerading as Managed Care?

Overt competition is a relative newcomer to the health care field-a field rarely even referred to as an industry a mere twenty-five years ago. In the early sixties most observers still considered commercial motives basically inapplicable to the delivery of medical services.\u27 But perceptions have changed now that more than 11 percent of the gross national product is spent on the health sector of the economy, a development made possible primarily because insurance to pay for expensive treatment and technology has become more widely available. Delivering medical services is commonly considered big business now, and the same kinds of competitive and anticompetitive behavior that have always been found in commercial markets can be clearly observed in the health industry of the 1980\u27s.2 Moreover, health insurers have evolved into major actors in the medical morality play, shaping policy as middlemen by managing the costs of care through vertical restraints on provider autonomy that might have seemed inconceivable to their cost-passthrough predecessors.

Why Don\u27t Doctors & Lawyers (Strangers in the Night) Get Their Act Together?

Health care in America is an expensive, complicated, inefficient, tangled mess - everybody says so. Patients decry its complexity, health care executives bemoan its lack of coherence, physicians plead for universal coverage to simplify their lives so they can just get on with taking care of patients, and everyone complains about health care costs. The best health care in the world is theoretically available here, but we deliver and pay for it in some of the world\u27s worst ways. Occam\u27s razor ( Among competing hypotheses, favor the simplest one ) is of little help here. There are no simple hypotheses - everything seems to conspire to make a bad situation worse. Moreover, despite abundant speculation, no one has yet come up with the silver bullet for reform. So why don\u27t doctors and lawyers, who consume health care themselves, get their act together and do something about it? Into this morass comes Peter D. Jacobson to offer cold comfort and a fiduciary band-aid with Strangers in the Night: Law and Medicine in the Managed Care Era, which illuminates why doctors and lawyers often have a hard time working with each other. The book promises to explain . . . how the legal system helps shape health care delivery and policy, explore . . . new ways of lookign at the relationship between law and medicine, and reflect . . . on why it all matters (book jacket). Professor Jacobson does manage to do that in the course of this purportedly limited examination of law and managed care, which he defines as the generic name for the new health care delivery system . . . characterized by large patient populations within integrated [i.e., combining financing and provisions of health services in one entity] delivery systems (p. 7). By the end of the book, however, one is left with a depressed sense that things could get a whole lot worse for all of us, not just for doctors and lawyers, before we just might - with luck - restructure the whole shooting match into a more humane and efficient health care delivery system

Medical Discipline in the Twenty-First Century: Are Purchasers the Answer?

The adaptation of medical discipline in the 21st century is examined by positing that the locus of disciplining doctors has already begun to gravitate away from traditional government licensure and medical malpractice litigation toward purchasers of medical services

FOREWORD: THE POLITICS OF HEALTH LAW: ANY TIPPING POINTS IN VIEW?

Malcolm Gladwell explored the way certain ideas and behaviors can proliferate just like viruses do once they achieve a critical mass in The Tipping Point,\u27 his best-seller about the sorts of widespread and rapidly adopted social phenomena he labels epidemics. Gladwell\u27s subtitle, How Little Things Can Make a Big Difference, indicates that he thinks it need not take much to get one of these social epidemics rolling. He does believe, however, that three factors are essential: getting people with a particular and rare set of social gifts involved,2 packaging the ideas so they are irresistible under the circumstances, 3 and making sure that both the right people and the right presentation can be deployed in the perfect context for change.4 That usually means inheriting or creating a situation where one can tinker[ ] with the smallest details of the immediate environment to unleash the idea\u27s potential for reaching a tipping point, and thus morph into an epidemic leading to change.5 As I thought about tying the six thought-provoking essays included in this Symposium on The Politics of Health Law together under some sort of unifying theme, Gladwell\u27s theories kept coming back to me. How would the issues these distinguished authors address-the Schiavo imbroglio, the constitutionality or criminality of palliative care, organ donation from minors, medical tourism and outsourcing, the way political ideology affects health care access, and pending federal legislation to expand individual insurance fare when examined through the lens of Gladwell\u27s analytical theories? Are any of the health care issues explored in this Symposium heading for the kind of tipping point that might change the way society traditionally grapples with them? The more I thought about using this organizing theme for knitting these seemingly disparate essays together, the more I came to view the articles as sorting themselves onto a continuum moving away from a theoretical potential for tipping point status, depending on how many of Gladwell\u27s three conditions for epidemic status were present. Whether Tipping Point theory really has anything predictive to say about the future course of these issues I cannot say, but the exercise has been an interesting way to tease apart their differences