The relationship between the providers of health care and the private companies, whether insurers, employers or other commercial payers, who write the checks is, and always has been, filled with some tension.  It could hardly be otherwise.  But this article from the Dallas Morning News from earlier this week reports the racheting up of that stress level quite effectively. 

I think one of the remarkable things we've seen in the last twenty years or so is the degree to which the locus of control over health care decisions has shifted from the patient and provider to the payer of those services.  There is a degree to which I understand the need and beneficial aspect of that.  But all good things must be carried out in moderation.  And my own experience is that, especially in some areas of medicine such as in mental health care, managed care has gotten out of balance.  With the upcoming change in administration, I think we'll see some vigorous contention in the ongoing struggle between providers and payers.

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