HMOs: Case of Dr. Kildare Meets Madison Avenue
Re: James Flanigan’s “Doctors Getting a Taste of a New Kind of Medicine” (June 4).
My distinguished forebears, grandfather H.M. Workman and father W.G. Workman, were both doctors who practiced in a day uncluttered by HMOs or even health insurance.
During their years, medicine was a very personal matter. One’s doctor was one’s friend as well as one’s medical benefactor.
Today, with the incredible proliferation of HMOs, medicine has become a fiercely commercial “Dr. Kildare, meet Madison Avenue” affair. HMO executive salaries are many times those paid their participating physicians, and this, coupled with heavy administrative burden, boosts health care costs to the patient. An additional 25% is a modest guess. With health insurance underwriters earning at least a 15% profit, health care today costs the patient at least 40% more than it properly should.
Here the American Medical Assn. has only itself to blame for its own inattention.
Harking back to grandfather’s day a century ago, the railroads were indeed the most adventurous, the most exciting industry extant. But their management, albeit ruthless in other areas, realized that health care was essential to their continued operation. Employee training and turnover was expensive; keeping them healthy and on the job was cheap. Thus the company doctor.
My grandfather was employed in that capacity in Tracy, Minn., by the Chicago Northwestern Railroad starting in 1881. My father joined him there in 1913 after graduating from medical school, serving the community--without ever denying care or attention to anyone--through 1963.
Clearly, it’s time for American industry to recognize this basic fact and proceed accordingly, hiring a company doctor or two or 10. Costly HMOs would be largely eliminated and health insurance rates would plunge. Doctors would then be back in the business of devoted health care and their patients’ savings would climb dramatically, all contributing to an improved economy.
A dream, you say? Not at all. America was built on dreams.
DAVID H. WORKMAN
Glendale
