HMO Competition for Physicians

The article about Physicians Who Care failed to indicate whether their main concern was for the quality of the care they were able to deliver or the size of the charge they would be able to pass on to their patients and to the insurance companies who cover their health risks. They seem to be clinging to a status that became untenable when the costs of health care rose beyond the ability of most individuals and organizations to pay.

The health-care delivery system in the United States has finally come face to face with the fact that it can no longer be afforded by even those of moderate means or those whose employment includes health-care benefits.

This country now spends more than $400 billion dollars each year for medical care while more than 33 million people are without any insurance coverage.

The Medicaid program nationally, now inadequate, faces a proposed budget cut of about $60 billion over the next five years. In California Gov. George Deukmejian has announced that, in his opinion, the state cannot afford the Medi-Cal programs that had been approved in this year’s budget.

Physicians Who Care bemoan the fact that a large percentage of doctors have signed up to deliver health care to patients through preferred provider insurance programs and health maintenance organizations. They complain that “gatekeepers” have a say in whether certain procedures should be administered to patients rather than the doctor having the decision alone. They further complain that many insurance plans and HMOs are controlled by “for-profit” corporations and entire chains of hospitals and nursing homes are also controlled by the same type organizations, which have no knowledge or devotion to health care but are only concerned about the profit they can earn.

They are correct in warning that corporate control of the health-care delivery system is contrary to the interests of the patients and should be outlawed. But they are wrong in suggesting that a return to the old system of fee-for-service is the answer. It is not only any longer affordable, it is not good for those patients who are able to pay the bills or the insurance premiums. Health maintenance organizations have shown that they can deliver health care for about 25% less cost than the old fee-for-service systems and still maintain a better longevity record than the old system. Perhaps this is attributable to the elimination of unneeded surgeries and other causes, but a patient who is a member of Kaiser Permanente is at no greater risk than a patient wiling to spend whatever money is required to avail himself of the care an unattached physician may recommend.

The new HMOs controlled by “for-profit” corporations may not be able to make the same claims as Kaiser, and other nonprofit HMOs have shown but they should never have been allowed to contract to deliver health care in the first place.

Probably by coincidence, an editorial appeared in the same edition of The Times that pointed out that health care in 21 industrialized countries in this world is about half the cost of health care in the United States and that only Canada and Sweden come anywhere near the U.S. expenditure (Canada spends about 8% of its gross national product on health care compared to more than 11% spent by the United States).

The editorial failed to mention that every industrialized country in the world, with the exception of the Union of South Africa and the United States, have adopted a national health plan that is available to all of its citizens. The health system in each of these countries is different and there are problems that each of them may have, but they do have health care availble to all.

Physicians Who Care would do well to divert their attention from the nostalgia they feel for the good old days when they were free to charge whatever they liked for their services. Those days are past and can never be revived. The individuals can’t afford it. Employer and employee groups can no longer afford it. The governments cannot afford it. A new system of organization for the entire health care system including doctors, hospitals, pharmacies, nursing homes, etc., will have to be organized that the American people can afford and that will meet the needs of the entire population.

DANIEL COHEN

Santa Monica