The two faces of managed care. Gekkonian managed care.
Gekkonians, on the other hand, find that the healthcare system is broken because it hasn’t been treated like the business it is. Allow free-market forces (that is, greed) to reign, and the problems will take care of themselves.
Accordingly, Gekkonians come at managed care from an entirely different direction. Historically, they have little claim to the managed care peerage. Gekkonians spent decades decrying managed care as socialist heresy. “Freedom and competition” is their battle cry, and managed care smacks too much of social engineering.
Since the 1980s, however, Gekkonians have co-opted the term “managed care” and changed its meaning. As managed care techniques derive from industrial management principles, they hold, managed care is actually a child of the open marketplace. Thus, Gekkonians seem to be saying, what managed care is really about is applying the principles of free enterprise to the business of healthcare.
Managed care to Gekkonians is dog-eat-dog, compete until you die, for-profit healthcare. Any actual relationship between Gekkonian managed care and classic managed care is incidental. (Sometimes standard managed care techniques can be useful, but only if they give you a competitive advantage.)
Managed care is a means of establishing stronger regulations on one hand and a means of maximizing profits on the other. Wonkonians and Gekkonians are both prominent today, and both groups are actively and loudly advancing their respective points of view. A lot of the turmoil we have seen over the past decades can be explained by the competition and interplay as they each try to advance their visions for American healthcare.
In the next few posts we will see how the Wonkonians are employing their concept of managed care in their continuing efforts to control the American healthcare system. But for more than a decade it has been the Gekkonians - armed with their chief weapon, the Gekkonian HMO - who have held center stage. Gekkonian managed care will be the main emphasis of this post.
But first a brief history of American healthcare - observing how the American healthcare system has drifted, across the healthcare landscape as defined by the GUTH - will help us to place into better perspective the reasons Gekkonians became ascendant in the mid-1990s, will help us understand why their flight path is now looking more parabolic than orbital, and will prepare us for the re-ascendancy of Wonkonians.
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