Horror Stories about Hmos Ignore Achievements of Managed Care

Article excerpt

Health maintenance organizations, better known as HMOs, are easy to hate. The charges against them are familiar: They take you away from your old doctor. They don't let you see a specialist without permission. They squeeze nickels until the buffalo screams. They lust after profits. They'd make saintly old Marcus Welby turn over in his grave.

No one is better acquainted with the complaints than Californians, roughly half of whom are enrolled in these allegedly money-grubbing, penny-pinching operations. As consumer activist Harvey Rosenfeld says, "HMOs have lost their traditional commitment to healing and caring. It's criminal what is happening."

On Nov. 5, Californians got the chance to put HMOs in their place with two ballot initiatives, Prop. 214 and Prop. 216, which would have established new regulations for the ostensible protection of patients. Surprise: The voters decided they'd rather trust the market than the government. The outcome represents a setback for the belief that no one ever went broke underestimating the intelligence of the American public. Californians were inundated with horror stories about patients who didn't get the right treatment because some HMO was too obsessed with cutting costs - and they were offered a pair of charming, painless solutions. Both would have outlawed certain bonuses for employees, prevented HMOs from imposing so-called "gag rules" on physicians and set minimum staffing levels for health-care facilities. Prop. 216 also would have restricted premiums and levied various taxes on providers. But the voters were not persuaded that all this interference was necessary. Everyone agrees that medical expenditures and insurance premiums cannot be allowed to keep rising at the rate they have in recent years. HMOs are the chief instrument we have found to put a brake on costs. But whenever they take some measure to achieve this worthy goal, howls erupt from people who liked the old way of doing things just fine - and think money is no object. Thus, we get measures like Prop. 214 and Prop. 216. Grownups understand that cutting costs is not fun. It means depriving people of things that they used to enjoy. But most of us are accustomed to the continual obligation to forgo some expenditures to avoid bankruptcy. HMOs, however, are the first innovation to force such unending, uncomfortable discipline on health-care spending. Small wonder that they evoke complaints from both doctors, who in the past had unfettered autonomy, and patients, who in the past could count on getting whatever treatment they wanted without laying out much of their own money. …