HMO Gag Orders, Health Spending

“Hippocratic or Hypocritic Oath?” (Commentary, Jan. 21) didn’t go far enough in its criticism of HMO-required gag orders on doctors. Precisely at a time in their lives when they are most vulnerable, patients are being forced to view their doctors as adversaries in their fight against disease--not as their allies. That’s why the HMO concept is intrinsically flawed and as such counterproductive to the basic needs of patients.

WALT GARDNER

Los Angeles

* California physicians no longer control their own destinies nor those of their patients. As increasing numbers of patients move into managed health care plans, physicians rival one another for slots in these HMOs lest they be frozen out of providing health care completely. If they speak out against their HMO, or suggest that patients pursue other options, they can find themselves unable to practice medicine at all.

My husband, a highly respected urologist in this community for 30 years, saw only two reasonable choices: to retire, or to leave California. He is now happily practicing in Ohio, where he and his patients decide what treatment to pursue. His integrity, experience and state-of-the-art professionalism are recognized, valued and compensated fairly. He does not even mind the snow!

BETTY RASKOFF KAZMIN

Los Angeles

* Re “Drawing the Line: an HMO Dilemma,” Jan. 17:

Denying patients the medical care they need--and have paid for--has become standard medical practice. HMOs all have gaping holes through which sick patients fall because HMOs provide as little--and as inexpensive--medical care as possible.

During the past six weeks, I have filed three complaints with the Medical Board of California, complaints against two doctors and one hospital for the grossly negligent and inappropriate care provided my wife because she belongs to an HMO, whose doctors were rewarded financially for denying her appropriate medical treatment.

The doctor’s admonishment to “do no harm” has been replaced with the HMOs’ creed to “do nothing,” thanks to greedy accountants who value increasing profits much more than saving lives or providing appropriate care.

HUGH W. GLENN

Irvine

* “ ‘Runaway’ Health-Care Spending? It’s the Engine of New U.S. Economy,” by Charles R. Morris (Opinion, Jan. 14) echoes what I have been saying for years now. Medicine as an economic endeavor is something we do well. So we should question the widely accepted idea that a financial stranglehold on health care will benefit either consumers or the U.S. economy as a whole.

Health-care spending cuts hurt everyone, but the effects are most evident to those of us who work in hospitals, clinics and pharmacies. Doing what is efficient and cost-effective inevitably forces us to compromise what is best for our patients.

But since we have decided as a nation to let the merchants allocate medical resources according to the “wisdom of the marketplace,” we can now expect all the ravages of the business cycle to set in. I’m talking about overcapacity leading to discounting, about mergers that will shrink capacity but leave thousands unemployed, and about shortages that will then lead to price excesses and overcapacity all over again.

The problem with the business cycle in health care is that shortages in good times and the low-ball budgets in hard times are going to take their toll in human lives and limbs. Lives and limbs that we know how to save.

ANTON DAHLMAN MD

Seal Beach