Howard Baker, MD

I am a psychiatrist and husband of Maggie Baker, who had been the co-chair of the media committee of the Coalition. (NCMHPC)

There certainly never was and never will be a need for the "inevitable" managed care.  Not only did they destroy the quality of psychiatric care, the true cost of the devastation they caused will probably never be known.

They merely managed to keep costs flat for a short while, but those flat costs included the huge hunk of the health care dollar that they took for themselves--meaning that what was spent of care of the sick was significantly reduced while the cost to those who paid for the insurance was held
constant.

It is comforting for those in the industry to believe that they did some good.  It might be argued that they did get doctors and other health care professionals to think about costs, which were specifically taught not to consider when I was in medical school, since our faculty thought that
would be a conflict of interest and our responsibility was to our patients.

Correlation is not causality, and there certainly could have been better ways to get this message out.

The simple fact is that there are no good inpatient psychiatric facilities in the Philadelphia area.  I do not know where to hospitalize people when they need it.  The options only include places about which I have significant reservations.  Worse yet, even if they do find some good care, the
treatment is too brief to be genuinely useful.  Soon there will be no people left who know how to use intensive milieu therapy, who do not even know that there is an effect that is genuine and helpful when the nursing staff makes a sincere effort to understand their suffering patients.  Please do not
misunderstand this to mean blame of the harried, overworked nurses in the present psychiatric hospital settings.  There is no way that they can do the best for their patients.  Nor will those patients see anyone who has genuinely improved--and that was a genuine help in the past.

That there was need to draw the attention of all of us to trying to reduce the cost of health care is true, and the only good that managed care has done is to get us to pay attention to that.  That goal could hardly have been accomplished in a worse way.

Jane undoubtedly has tried to do an ethical job on both sides of the "market", but it is true that those unethical practitioners who gave unnecessary treatment have to confront their suffering patients directly, and that above all else provides some sort of ethical brake.  I do know that this
unnecessary care was given, but I do not think it was anywhere near as harmful to those patients as the present situation in which we simply can not give good care.  For the care manager who never has to put a face on the suffering patient or the suffering person who is trying to treat them with one hand behind their back, that ethical check is absent.  I know, of course, that that check is absent for those of us who find it difficult to believe in the humanity of the care managers; and I am certain that we all try to grant that to those in the industry that we know.  However, we are not in a position of power in relationship to them, and they are in a position of terrible power in relationship to us and our patients.  It is difficult to abuse people you know, although we all know from our clinical experience that this happens.

We also know that when the abused person stands up and makes the abuse clear, it often has an impact on the abuser that leads them to stop.  The set up of managed care keeps them protected from that information--it is rare that they see the suffering that they impose on patients and on the health care system and those who try to provide care.