Health care is falling apart under weight of HMOs

Published 12:00 am Tuesday, July 13, 1999

From staff reports

AUSTIN, Texas – Health care in this country is such a mess that the doctors have decided to unionize.

Tuesday, July 13, 1999

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AUSTIN, Texas – Health care in this country is such a mess that the doctors have decided to unionize. It’s enough to make a cat laugh. Solidarity forever, Doc. Hit the bricks, bring the company to its knees.

I feel some sympathy for the doctors, who are indeed in a horrible pickle – many forced by the HMOs they work for to give the &uot;least costly&uot; treatment no matter how much better another treatment might be.

I would feel more sympathy for the docs, however, had the American Medical Association not been a key player in wrecking the original Clinton plan for universal health coverage. And one suspects what the docs are really upset about is their falling income. In those long-ago days of 1993, the docs screamed that the Clinton plan was socialized medicine. So instead we got corporatized medicine, and aren’t we having fun now?

Of course, the docs weren’t the only or even the major player in defeating the Clinton plan. It’s interesting to see how much ignorant commentary about that horror show is still being spooned out. The New York Times recently attributed the plan’s failure to its complexity and &uot;hubris&uot; on the part of the Clinton administration.

Maybe the administration didn’t have the political skills needed to pass major legislation, but how would we know, since the bill was buried by money? It was defeated by more than $10 million in advertising and lobbying, and that’s not even counting campaign contributions, according to several studies.

No one had ever seen that kind of money spent to defeat a single bill before. It came from several sources, but the biggest chunk came from the insurance companies, sponsors of the famous &uot;Harry and Louise&uot; ads. And guess who the big winners are in the current system?

Remember how competition was going to lower costs, and the genius of the marketplace could not be interfered with, and how horrible it would be if the people who ran the post office ever got their hands on the health-care system?

As someone else observed, if the people who now run the health-care system ran the post office, 43 million Americans would never get any mail, not to mention bad and expensive service for the rest of us. Only 29 percent of those polled rate their HMOs as very good.

Recently, the Justice Department, showing the spinelessness for which it is so noted in these matters, approved the merger of Aetna and Prudential. The merged company will provide healthcare for one in every 11 Americans, and that makes it big enough to downsize services, hike prices and force doctors to accept unreasonable contract provisions and reimbursement rates.

According to Consumers for Quality Care, in some markets the new giant will cover more than 50 percent of the patients, so neither the doctors nor the patients will have any choice.

Just a few years ago, there were 18 big HMOs; today there are seven, just like the seven sisters of the oil industry: Aetna, Cigna, United HealthCare, Foundation Health Systems, PacifiCare, Wellpoint Health and Kaiser.

All seven of the giants decided – independently, of course – on the very same day last year to dump rural seniors on Medicare. They also decided, in perfect concert, to cut back on the prescription drug benefits and no co-pay policy that got the seniors into the HMOs in the first place.

And every one of the seven has substantially hiked premiums for all their patients this year. And just over week ago, they announced they were dumping another 250,000 Medicare patients, as well as cutting benefits and raising premiums.

We were supposed to be able to keep HMOs in line by quitting ones that provided poor service or cost too much, but it hasn’t worked out that way. Only 17 percent of employers offer workers a choice of plans. Everybody else is stuck with whatever the company chooses, and the company chooses by cost of premiums, not by quality of care. As USA Today recently noted, &uot;Even without consolidation in the industry, patient choice has been slowly but inexorably vanishing.&uot;

For all the complaints about the complexity of the Clinton plan, the fact is that health care is a complicated deal – unless, of course, we had enough brains to go to a single-payer system.

The 43 million who are still uninsured are simply ignored by politicians. Many of them use hospital emergency rooms as their health clinics, costing the rest of us a bundle.

The pharmaceutical companies continue to rip off customers. The need for insurance covering nursing homes becomes more critical every year. The home health-care industry is practically in a state of dissolution, since the government drastically cut its payments.

Clinton has now moved to address a single facet of the complicated mess – extend Medicare to cover prescriptions. This is a right move, as many seniors go without food to pay for prescriptions, or take half the recommended dose, or one spouse goes with no medication so the other can get what he or she needs.

And it is also a smart move. The system now operates backward in terms of effective care. It covers doctor and hospital bills, but not outpatient prescription drugs. If seniors could get the medication they need, far fewer of them would wind up in the hospital in the first place, thus saving everybody a lot of money.

The question is whether Congress has enough sense to do the right, smart thing. Some of members, like Tom DeLay, are so anti-Clinton that they’d vote against a resolution in favor of motherhood if Clinton proposed it.

If the Republicans wanted to do a right, smart thing of their own, they could easily improve Clinton’s proposal by requiring affluent seniors to pay for more of their medical benefits and dropping the subsidy to employers who already provide drug benefits.

Think they’re smart enough to do that?