Understanding The Managed Care Backlash

PROLOGUE: Managed care has been described with terms as forceful as “revolution.” Given the sweeping implications of such a word, a negative reaction is inevitable on the part of persons and institutions that are affected. For managed care, the “backlash” has taken the form of legislation introduced in nearly every state (more than one thousand bills at last count), aimed at calming consumers' fears of losing control of their health care while trying to retain some of the cost-saving, market-innovating features that managed care has brought to the U.S. health care system. Robert Blendon and a team of highly respected survey researchers have assembled the latest polling data in an attempt to understand the nature and extent of this backlash, which has been widely reported in the media. Blendon is professor of health policy and political analysis at Harvard University in Cambridge, Massachusetts. Mollyann Brodie is a senior researcher and director of special projects at the Henry J. Kaiser Family Foundation in Menlo Park, California. John Benson is deputy director of the Harvard Opinion Research Program, Harvard School of Public Health, in Boston. Drew Altman is the Kaiser Family Foundation's president, and Larry Levitt is director of California grants and the Changing Health Care Marketplace project at the foundation. Tina Hoff is director of media relations and senior communications program officer at Kaiser. Larry Hugick is director of political and media polling and senior project director at Princeton Survey Research Associates in Princeton, New Jersey. ABSTRACT: This paper examines the depth and breadth of the public backlash against managed care and the reasons for it. We conclude that the backlash is real and influenced by at least two principal factors: (1) A significant proportion of Americans report problems with managed care plans; and (2) the public perceives threatening and dramatic events in managed care that have been experienced by just a few. In addition, public concern is driven by fear that regardless of how well their plans perform today, care might not be available or paid for when they are very sick.