Cockburn Right on Canyon Oaks Fiasco : Healthy Debate About HMO Plans

* As a corollary to Roselle M. Lewis’ horror story of her experiences with her health maintenance organization (Valley Commentary, Jan. 2), here is the other side of the coin.

In the early morning hours of July 5, 1993, Mrs. Moss was suffering from shortness of breath. In night clothes, we rushed to the North Hollywood Medical Center emergency room, where she was given all possible tests and exams, under telephonic communication with her personal cardiologist.

Stabilized, she was taken by ambulance to Valley Presbyterian Hospital, where she stayed for eight days. Two different specialists were called in, and we were warned that she might require open-heart surgery to stay alive. That was to be determined only after additional treatments had been tried and the results observed.

We are delighted to report that no heart surgery was needed, that she came home to our massive administration of TLC from members of our family and is today feeling quite well, albeit requiring extensive medications.

My point of view is stark and scary. Under the proposed Clinton “Health Care” plan, all persons in the United States would be subject to only managed care. In this instance, she would not have survived.

What Bill and Hillary are saying in their managed-care proposal is that they don’t give a damn if we die, just so long as they save money. We prefer to choose our doctors and live.

EDWARD H. MOSS

North Hollywood

* Roselle Lewis’ article continues in a process that became popular during the past few decades--doctor bashing. But the process is dated. It’s based on the mistaken assumption that doctors alone constitute “the healing profession.”

In fact, today’s healing profession is top-heavy with unseen, unknown, nameless professionals whom Lewis called “the parties engaged in managing my care.” Their jobs are patient retention, market-share analysis, provider relations, cost containment. They create and mandate HMO policies, policies that denied Lewis an overnight admission to a hospital for observation, denied her “primary care physician” the option of referring her to an orthopedist and probably will also deny her the physical therapy that “later on” might be “recommended.”

But does Lewis ask these new members of the health care profession to be patient-oriented or compassionate? Does she decry their indifference or their gum chewing? Of course not. She doesn’t know who they are. So she targets the professionals she can see, name and talk to: doctors, nurses and an emergency room attendant.

She said the HMO managers’ first consideration is cost containment, yet she seemed to pardon them and punish the providers whose hands were tied by her own HMO’s restrictive policies.

Let’s be fair. In the new era of managed care, let doctor bashing be joined, if not replaced, by management bashing.

CHERYL HUNTER COOPER,

R.N.

Toluca Lake

* It was clear from Roselle Lewis’ graphic description that care had not been rendered as she had expected, based on her review of brochures and advertisements about her senior plan with her health maintenance organization. It even appeared questionable, from Lewis’ accounting, that proper care had been provided.

Considering that HMO medicine often rewards providers for providing less not more care, spending less not more money, this has become more and more the case--but it doesn’t have to be.

What was missing from Lewis’ account was any mention of how she had selected the providers within her HMO plan, not the emergency room to which she was brought after her accident, but the primary care doctors and hospital network she had selected upon signing up for her HMO plan years before. The performance results of any plan directly relate to the providers one selects within the plan’s network. The HMO is truly just the payer of the bills.

Some medical groups or independent practice associations focus on bonus incentives and profitable rewards for physicians who withhold care that subjectively may be described as unnecessary.

However, other medical groups within the very same health plans may be more “generous” deliverers due to incentives for quality, the size of the groups themselves and the individual doctors within them.

Consumerism can assist individuals select HMO plans and providers. Before signing up, obtain a list of physicians and hospitals in the plan’s network. Call them, ask questions and give them examples of what type of care you think should be required.

As our country becomes more and more directed into HMO-type plans, it is in everyone’s interest to play an active consumer role in both the plan and the provider selection. That way, there will be fewer disappointments.

SARI D. WEINER

Tarzana