Managed Care for Seniors

Westcott W. Price III correctly states in his March 14 commentary that health maintenance organizations provide substantial benefits to Medicare enrollees. These include coordinated care, more services, such as prescription drugs and preventive care, and significant cost savings. However, his article was misleading.

First, HMOs do not save hundreds of millions of federal dollars. A recent study by New Jersey-based Mathematical Policy Research found that enrolling Medicare beneficiaries in HMOs costs the government money because of biased selection: Healthier Medicare beneficiaries join, while those with disabling illnesses stay with the private fee-for-service doctors and hospitals they know.

Second, Medicare HMOs are not the panacea that Price claims. HMOs can and do provide high-quality care for Medicare beneficiaries. Nevertheless, Medicare HMO enrollees often call the Health Insurance Counseling and Advocacy Program (HICAP), a program of the Center for Health Care Rights, with problems relating to delays in referrals to specialists, denials of care and payment for out-of-plan emergency care.

Los Angeles County Medicare beneficiaries with HMO or other Medicare questions can call HICAP at 800-824-0780.

GERALDINE DALLEK MPH

Center for Health Care Rights

Los Angeles

* By moving more senior citizens into managed-care programs enough would be saved in Medicare costs alone ($1,200 a year per Medicare-eligible senior) to cover the uninsured. That is the thesis of Price, CEO of the country’s third-largest HMO. According to Price, “Americans spend $1 trillion, 14% of our gross domestic product, on health care. Based on the experience of other major industrialized nations, we should be spending only $600 million to $700 million.”

What Price does not mention is that all those “major industrialized nations” honor the human right to good health care of all their people with single-payer, tax financed, universal, comprehensive health care that includes long-term nursing home care that is not provided by Medicare, nor most private insurance and HMOs. France, Germany, Japan and Canada also provide free choice of private health care.

Price makes no mention of the private market’s negative developments of unprecedented marketer intrusion between doctor and patient, and diversion of health-care dollars to wasteful administration, obscene CEO remuneration, real estate and duplicated equipment investment, advertising, lobbying and political campaigns.

As the rest of the major industrialized nations have amply demonstrated for up to half a century, improved health care for all with real savings in dollars can only happen when we extend Medicare with genuinely comprehensive health care to all our people, our children and grandchildren.

NICHOLAS V. SEIDITA

Northridge