I had an interesting thought about this discussion and wanted to share this
to see what others think. In 1998 the US spent $1 Trillion Dollars on Health
Care.  In an article I read recently, a large percentage of this was due to
increase in pharmaceutical cost.  The article described a catch 22 theory.

Managed care in the US was started due to the uncontrolled spending we were
having in the 80-90's.  The theory behind managed care was to control
spending by promoting healthy life style, behavior changes for those
conditions that lead toward illness, obesity, smoking, alcohol and drug use
to name a few as well as early detection of problems so that treatment could
be started and that for those with chronic disease, assist those to be
adherent to treatment so that they would not have the major setbacks that
are costly.  Some examples were...Diabetes, COPD, Hypertension, Asthma etc.
This is the premise behind Disease State Management.

The catch in this is that when you identify all these people to promote
health you have increased cost! How do we (the Healthcare system) handle
this...by writing prescriptions! Doing test, and having more MD visits for
check-ups and follow-ups. Example: Person put on Antihypertensive meds, need
to have the meds refilled every 30 days, needs to make sure that the med is
working. So we need blood work, and a visit for the MD to evaluate the
patient. The patient also needs  a B/P cuff at home in order to check
his/her B/P to see if they are in control. So much goes into this! The end
result is a more compliant, controlled patient that will not have that CVA
at 50! Also on the down side is higher cost to the MCO due to in drugs, due
to education and other testing that has to happen to make this work. The
masses (all of us) are now starting to realize that if they take care of
themselves, they will not only live longer, but hopefully more healthily.
Again, rising cost of meds and cost to the healthcare system.

This has caused major problems for Managed care companies as they lose money
when we ALL take advantage of the system.  The per member per month rate is
charged even if you never go to the doctors! If you go, then there is an
actual person who came to the MD office, who needs to be examined, labs done
(even preventive ones cost money, and if you have a problem, than you will
probably be given a script!). So MCO's are actually losing money and they
don't like to lose money, so rates go up which causes the employers to
search for another plan, because they cannot afford the increase in the
premiums which they pay the bulk.  The MCO in turn loses members.  So the
MCO's who have aggressive wellness plans and DSM programs look at this as a
negative.

It is estimated that the average member only stays with them for a short
time. The theory of wellness and prevention may not be realized for many
years and by then, the member who  you spent so much money on is with
another health plan!   The solution......government run healthcare! So at
least we are all working toward the same goal...to simple! Let's hear from
those who have government run healthcare...

    Does it work?
    Are you happy with it?
    Is prevention apart of the plan
    How are people with chronic diseases and illnesses handled?
    What happens when you "really get sick...with HIV/AIDS, cancer all the
Big         One's".?
    How are end of life issues handled?
    Is withholding treatment encouraged? Ex. 67 year old female in fairly
good         health with a new lump on her breast...will the patient be
treated aggressively

    Thanks Anne Llewellyn, USA