If there was one issue that unites all our top election candidates, it is strong criticism of managed care. On the front cover of the same issue, UnitedHealthcare was criticized for not removing utilization review for mental health. Whereas the criticisms may be warranted for many managed care companies, it seems as though we are ready to "throw the baby out with the bath water," since there do not seem to be any solutions to the problems that managed care has tried to address.

Managed care was born because there were major problems in our health care system, including mental health. Capitated behavioral carveouts occurred because the rise in behavioral costs was even higher than other kinds of medical costs. Utilization review occurred in part because our peer review was ineffective. Networks developed in part because of wide disparities in quality of care. Scandals in some of the for-profit hospitals seemed to justify reduced lengths of stay. Although our treatment guidelines are wonderful summaries, managed care companies are developing much briefer, easier to use guidelines. Because proof of our efficacy has been questioned, outcome studies are emerging.

If managed care disappeared tomorrow, what would take its place? Like good psychodynamic psychotherapists, let’s look at our own prior problems and come up with new solutions instead of just blaming managed care.