By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
The good news, Griffiths says, is that the companies' representatives have shown a willingness to figure out a way to get his kids covered under Northstar.
"Everyone wants to paint these guys as evil money mongers, and that's not the case. They're just seeing that their managed-care system doesn't work in Texas," Griffiths says. "We are working with the officials to sift through the process, and we have gotten their commitment to work out the problem. Will it happen soon enough for the providers? I don't know."
Magellan's Waters says he's optimistic that New Place's closure won't become part of a trend. "I would not in the foreseeable future expect to see more closings," Waters says, "but this is a business."
Oddly enough, the complaints from drug treatment counselors fall on less sympathetic ears down in Austin, where the prevailing attitude is increasingly Darwinian.
"Do I think some [centers] may shut down?" the state's Gillies says. "That's really out of the state's control. If they are going to continue to do business the way they used to, some of them may not survive."
Wanser, sounding much less like a negotiator, has even less tolerance for his critics. "There have been some people whose single focus for the last two years has been to prevent this from happening," Wanser says. "Well guess what? It's happened."
Dallas County Commissioner Mike Cantrell laughs when asked whether he thinks Northstar will cure the county's financially strapped public-health system.
"No, we didn't want Northstar. No, we couldn't stop it," Cantrell says. "I still don't believe when you break the money up between two [companies] you're gonna have less administrative costs. If you're taking profits out that aren't being reinvested into the system, that's taking away from the services. That money is leaving the system."
A fiscal conservative, Cantrell has taken a leading role in helping the county adjust to the more competitive environment Northstar creates. As part of that effort, the county revamped the old MHMR department by trimming its administrative overhead, laying off some staff, and renaming it Dallas Metro Care Services Inc. It's a more business-sounding title that reflects its new businesslike mind-set.
"We are looking more and more like a private provider as the days go by. People who used to be our contractors are now our competitors," says Jim Blagg, Dallas Metro Care's executive director. "We have not experienced any consumers falling through the cracks and not getting service. That doesn't mean they won't in the future."
Like Cantrell, Blagg doubts Northstar can deliver on its promise of improved care for the county's indigent population unless state lawmakers give the companies more money.
But Dave Wanser says that more state funding is not an option. "Our Legislature is not of the mind to spend much more on social services. So the fundamental question remains, How do you stretch your dollars and get the most bang for the buck?"
To Dr. Glenn Pearson, the new clinical director of Dallas Metro Care Services, the only answer is to reduce care, something he is loath to do. "Health care is not a commodity," Pearson contends. "Though it is not listed in the Constitution, increasingly people view it as a right, but we're increasingly treating it as a commodity that can be dealt with by businesses."
"Managed-care companies have an incentive to limit care," says Dr. Joel Feiner, the director of Mental Health Connections, a unique program that helps the severely mentally ill learn to live with their illnesses. "Once you put a pricetag on [health], then you're subjecting it to all the market forces that products have, including their ability to bring large salaries for the president of the board and the stockholders."
Even in the private sector, managed-care companies already operate on what Feiner calls the "shameful assumption" that there is a limited amount of money to go around, which means that the gap between the haves and the have-nots grows wider.
"What the doctors have been forced to do is weigh the many against the few," Feiner says. "The question becomes, Why are there such limited resources at a time when the economy is thriving?"
As part of the temporary moratorium on the state's managed Medicaid program, state lawmakers will soon renew the debate over how much the health of the state's most impoverished citizens, including those affected by Northstar, is worth. Although money will drive the debate, Rep. Garnet Coleman argues that his colleagues must consider the broader philosophical questions managed care raises.
"If the [companies] are not interested in the health of the patient, that patient may very well die," Coleman says. "The state cannot take lightly the real importance of the role we are giving these companies." Instead, Coleman says, the state must consider two questions before it decides to make managed health care a permanent reality.
"We have to determine, one, Are we saving money and, two, Is this detrimental to care? Those questions are not answered," he says. "We want to make sure that managed care in the public system is working. The jury is still out and, yes, I'm worried."