The Shift Towards Managed Care by Traditional Payers

In our country it is said that 48.8 million citizens have Medicare insurance while another 65 million have Medicaid ( Meaning a large amount of the citizens in the US depend on government assistance for health insurance coverage. This is why managed care has become more and more popular. Managed care limits the amount of healthcare one receives to be limited. These limitations prevent patients – as well as physicians – from over using healthcare funds, which in turn cuts cost.

Many in our country cannot afford the rising cost of healthcare, so they desperately depend on our government to help cover this necessary cost. The problem is the government is not where the funds come from. It is the tax payers who pay for this coverage. This brings up the debate, is managed health care helpful or not? One may say it is unfair to raise taxes to cover the less fortunate, but another might feel it is unfair to place limitations on needed healthcare procedures or supplies to save money.

The shift to managed care has taken place to guarantee the government becomes responsible for this coverage. They have formed this "treaty" one could say with physicians and insurance companies that limits healthcare to citizens by leading them to think that the free to low premiums are allowing them to be covered in case of a medical emergency. Yes limitations are needed in this area, but we have to remember this area deals with the lives of others.

Managed care plans lead patients to circumstances where they have no choice but to attempt to pay cash prices for needed healthcare. They allow a manager to say yes or no to care verses the physician. The physician at this point has no choice but to allow the patient to pay cash for the needed service, per their contract. The physician receives a fixed rate for seeing patients that are in this managed care network therefore leaving no way for their office to try to appeal the manager's denial of benefit.

Manage care plans will continue to grow within our country not for patient benefit, but for government and insurance funds protection. Patients will continue to see a rise in taxes but no rise in the quality of their care. This shift has not helped in any way, but only came into play to blind patients to what is really going on behind the scenes of healthcare.


1. Jeffery B. Terrance, (October 18, 2012). Medicaid and Medicare Enrollees Now Outnumber Full-Time Private Sector Workers. Retrieved from

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