Not Just for Bureaucrats Anymore

Abstract

Managed care is increasingly subject to political micromanagement and to attacks in the press. Managed care is undergoing the kind of bureaucrat bashing familiar to government employees, because managed care plans are being asked to perform the same type of allocation of social resources (in this case, access to health care) typically conducted by government employees. In so doing, managed care has run afoul of two deeply ingrained American traditions: bureaucrat bashing and overhead democracy. This article uses a case study of managed care bashing to argue that private interests who perform a role in allocating social resources will be subject to the same type of criticism government employees face in allocating social resources (bureaucrat bashing), as well as political leaders’ impulses toward control (overhead democracy). The ombudsman model of governing managed care is advanced as an alternative to managed care bashing and overhead democracy.

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