What’s in a Name? That Which We Call Medicare Advantage Is Managed Care by Any Other Name

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One of Shakespeare’s most famous quotes comes out of his play “Romeo and Juliet.” Though there are some historical omissions and differences in the original editions of the play, the most well-known version of the quote may be:

Juliet laments: “What’s in a name? That which we call a rose, by any other name would smell as sweet.”

The meaning is often interpreted as an attempt to minimize the conflict between their 2 families, the Montagues and the Capulets. However, the conflict proves too hard to overcome in the tragic end of their relationship.

It now appears that something like this has happened with managed care. As the controversial for-profit managed care business control of medicine emerged in the 1990s, managed care soon became a dirty word in psychiatry.¹ The conflict was between the profit motive of the managed care business ethics versus the psychiatric and health care ethics of putting patient needs first and foremost.

Somehow, as “Obamacare,” aka the Affordable Care Act, emerged during his presidency, the term managed care started to disappear, though the business did not. It was still managed care by any other name.

One of those names is Medicare Advantage. These are the private Medicare coverages that enrollees can choose instead of the traditional Medicare. They now cover about 28 million elderly individuals. Unfortunately, as found in a new study, one of the results is an inadequate network of psychiatrists in Medicare Advantage plans.²

Some years back, after my book on managed care ethics came out, I was involved with the American Psychiatric Association’s council on Healthcare Systems & Financing. Now, the Chair—Robert Trestman, MD, PhD—decries such networks as being “ghost networks.”³ According to Trestman, not only do patients enrolled in that system have trouble finding a psychiatrist, but they are demoralized in the process. Psychiatrists seem to be avoiding these plans due to low reimbursement, extensive paperwork, and less control over resources.

Just like Shakespeare’s roses may smell as sweet with any other name, they still have thorns. Managed care with any other name is still a for-profit business that puts obstacles to obtaining quality of psychiatry care in favor of profit.

Recently, I have noticed many television ads about Medicare Advantage, but none about traditional Medicare. As in most business purchases, buyers beware!

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.

References

1. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

2. Zhu JM, Meiselbach MK, Drake C, Polsky D. Psychiatrist Networks in Medicare Advantage Plans are substantially narrower than in Medicaid and ACA markets. Health Aff (Millwood). 2023;42(7):909-918.

3. O’Connor K. ‘Ghost networks’ put patients at risk of becoming more ill. Psychiatric News. May 26, 2023. Accessed July 27, 2023. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2023.07.7.10