Managed Care

* In calling for greater use of managed care in the Medicare program (editorial, Aug. 7), The Times has put the cart before the horse. We’d better make certain that managed care is willing and able to serve the kind of population that Medicare represents.

Senior citizens aren’t the only ones who depend on Medicare for their health care. Many younger people with disabilities (including those with multiple sclerosis) also are Medicare beneficiaries. But traditionally, HMOs have worked much harder at avoiding coverage for this population than they have at finding efficient ways to deliver needed care.

The fact that politicians increasingly believe that managed care is the way to save Medicare is hardly reassuring. Despite state medical audits showing that most Medi-Cal managed-care contractors consistently performed in ways that compromised the quality of care, continuity of care, care management and even the preventive care that HMOs so often promote, the state renewed contracts with these plans. Is this what we have to look forward to with greater Medicare use of managed care?

LAURA REMSON MITCHELL

Government Issues Coordinator

Multiple Sclerosis Society