It is the free mind and individual responsibility, the principles of the Renaissance that have brought us the wonders of modern health care through the free-market capitalist system and through the inventiveness of the free minds it has raised. It seems we are now going to harness the capitalist engine for rationing....
The world owes all its onward impulses to men ill at ease.
The happy man inevitably confines himself within ancient limits.
Nathaniel Hawthorne (1804-1864)
On Managed Care And Cutting-Edge Technology
The decade of rapid growth of the HMO embryo has now reached the turbulence of adolescence. Whether this brand of irrational medical financing will transform itself to rational adulthood or merely self-destruct is now open to conjecture. It is important however, if not critical, to understand the likely future of HMOs, as politicians, business institutions, and medical groups are currently making strategic decisions dependent upon HMO maturity and permanence. Decisions made upon such a premise are very likely to be ill conceived.
Managed Care (HMO) Dissatisfaction
Dissatisfaction with managed care and HMOs continues to grow. Readers of the Medical Sentinel should find of interest (but not surprising) the following aggregate of opinion polls conducted by The Wall Street Journal, Harris Polling, ABC, Newsweek, and both political parties:
The percentage of Americans that believe managed care has hurt the following aspects of medical care:
Nurses, Doctors, and HMOs
In case you have not heard, the managed care industry has instituted another divisive measure that is bound to cause resentment within the ranks of medicine: Oxford Health Plans, Inc. and Columbia Presbyterian Medical Center have struck a deal to assign primary care status to nurse practitioners who will be paid at the same rate as physicians.
HMOs Are NOT "Free Market"
M. Stanton Evans, the prominent journalist, has vindicated AAPS and many of us who have (1) exposed managed care and HMOs for what they are: collectivist engines harnessed for the rationing of medical care; and (2) denied the contention that HMOs are “free market.” Writing in Human Events (12/6/96), he states:
Jan Malcolm, Vice President of Public Affairs for the Allina Health System, Minnesota's largest HMO, was appointed on January 19 as Minnesota's new Commissioner of Health. We question whether Commissioner Malcolm, a top-ranking HMO executive, can effectively deal with the problem of managed care.
Dear Dr. Orient,
HMOs have destroyed many long-term patient-physician relationships, they have created an ethical conflict of interest for physicians who must agree to withhold care to their patients for profit, and they have perpetrated the biggest scam of all time on patients whom they have promised "something for nothing." Managed care has unquestionably lowered the overall quality of medical care available today. But is this as bad as it gets?
As I picked up the front page of the USA Today in the doctor's lounge, an article caught my eye. The headlines read: "Health-Plan Cost to Soar This Year." Even though I was late to start my myelogram, I sat down to read this incredible headline. It reported that large health benefit plans' costs will go up 7 percent on average this year, almost twice the rate increase of last year. But, of even more interest, it is drastically higher than the 1.5 percent inflation rate.
Inflammatory HCFA Notices
A new Republican health care proposal, spearheaded by Rep. Tom Bliley (R-VA), would greatly expand freedom of choice and control by workers and consumers over their health coverage and care. This idea would be far more effective in helping patients than federal regulatory proposals masquerading under the label of a patient bill of rights, which would actually reduce the freedom of choice of patients in some ways.
The Health Mart Proposal
As a physician my main concern is the health of my patients, and they are the ones who make the medical decisions for their care, treatment, drugs and consultations.
I came to this country because I wanted freedom of choice and the freedom to practice medicine in the best way possible. The first ten years I was able to work in my profession as I believed it should be done, but now I am very disappointed because of my inability to practice medicine the way it needs to be practiced, in the tradition of Hippocrates.
As Medical Sentinel readers may know, particularly my Ob/Gyn colleagues, many insurance companies and HMOs have instituted "prenatal wellness programs" (PWPs). Typically, patients are called or induced to call the company and a company nurse records a detailed medical history including sexually-transmitted diseases, abortions, etc. These programs are represented to patients as being "in cooperation with" or "with the participation of" patients' physicians. But physicians received only a computer printout copy of the record generated by the insurance company.
Though several political hurdles remain, U.S. consumers could soon have new protections against alleged abuses of "managed care" and HMOs (health maintenance organizations).
At the forefront of the new developments are competing bills in Congress, passed by the House and Senate respectively, now scheduled to be reconciled in conference. Simultaneous with these proposals, state legislatures and the courts have also moved to impose new limits on managed care. Obviously, the national backlash against HMOs is having a significant impact.
It has been said that there is no such thing as coincidence --- that all happenings have their reasons. Several days ago, I was conversing with physician friends about the reasons for the current medical and professional dilemma, physicians and patients finding themselves hopelessly overwhelmed by the government and the insurance industry. On the following day, while purging files in my den, I came across an article on this very subject, which I had written in 1995. The article went like this:
As might be expected from the rave reviews by Physicians for a National Health Plan, As Sick As It Gets offers a single diagnosis and a single prescription for whatever ails any non-rich American.
With the definite resurgence of the medical liability crisis, a recapitulation of the AMA's campaign for the implementation of tort reform in the last several years is in order to better understand where we have been and where we are headed in our struggle for meaningful and substantive medical liability ("malpractice") tort reform.
Is the general practitioner being cast in the role of a medical reject or is there a holocaust of general practitioners?
"You cannot be on our hospital staff because you are not a board certified specialist," said the hospital. A holocaust maneuver by the hospital?
"You cannot be one of our physicians," said the HMO, "You do not have a specialty board we recognize." A holocaust maneuver by the HMO?
Your March 3 editorial "Health Care Industry Wearing Blinders," brings to light much that is transpiring today in health care delivery - from "cowardly" public relations responses at the state legislature to "cynical" radio ads by the managed care industry.
The public outcry you described and the horror story testimonials aired in WMAZ's All About You, managed care series - all support my contention that we are headed in the wrong direction, toward more corporate socialized medicine, to the detriment of patient care.
Although I agree with your editorial on unionization, I must ask why are physicians really forming unions? Why are editors of medical journals, such as the Annals of Internal Medicine (April 20, 1999), calling again for "universal coverage" and "health care as a right?" They are already anticipating the collapse of the "managed care free market system" under its own bureaucratic weight, and are hoping that the government will save us from the crisis with the single payer system.