Execs Stay Healthy Under Managed Care

Columnist James Flanigan (“The Changing State of Managed Care,” June 23) was partly right by quoting analyst Kenneth Abramowitz’s statement that managed care “is a transfer of wealth from doctors to corporate America.” He would have been more laser-accurate were he to mention health industry executives in this list as the major benefactors and to add hospitals as the major victims since doctors’ fees constitute only about 18% of the health-care dollar. Notable by its absence is any mention on the benefits for the patients themselves.

Perhaps it is also naive to believe that altruism alone will propel the best talents in our nation to seek a medical career once the compensation falls below a certain critical level. At least one head of a National Institutes for Health division was forced to quit his prestigious job for private medical practice mainly because he could no longer sustain his children’s college expenses on his income from the agency. A calling to serve may be burning in one’s heart, but even a mother hyena is genetically compelled to provide well for her offspring.

Not mentioned in Flanigan’s commentary is the consistent trade surplus from medical exports our country has enjoyed for having been the undisputed leader in medical advances and pharmaceuticals. Yet we are readying ourselves to cede this dominance by choosing exclusively cost effectiveness over innovation and research. Instead of funneling this transfer of wealth from doctors, hospitals and consumers into medical research or a reduction in premium for comparable coverage, we are seeing instead much of this transfer going into the hip pocket of the administrators whose annual compensation not uncommonly runs up to the millions.

Although I have never been a fan of expanding the government’s role any further, it is dawning on me that perhaps universal health care may well be the lesser of the two evils after all. At least the care we receive will then be at least mediocre instead of Kevorkian.

Dr. JOHN T. CHIU

Corona del Mar

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Once again, an article in praise of the managed-care industry, detailing the success in reducing the price of health care, with absolutely no mention of the negative effects of this movement--a movement that has enriched the major players in the industry not only at the expense of physicians but also at the expense of professional nursing care.

Are you aware that there is a growing movement to take the registered nurse out of pre-hospital care? That means that a medical diagnosis will be made and treatment instituted by a person with four months of education and two months of supervised practice (by another paramedic) with no input from either a registered nurse or a doctor?

Are you aware of the cuts in staffing and the “dumbing down” of nursing care that takes place whenever HMOs achieve strong bargaining power? Do you really think that they can command 10% to 20% cuts in hospital charges without that having an effect on the professional nursing care, the need for which sent you to the hospital in the first place? (You do know, don’t you, that the single criterion that most nearly describes whether you will be allowed to enter a hospital for care or will be required to obtain that care at an outpatient setting, in home care or other is: Do you require professional, i.e. RN, nursing care?)

Interestingly, the nurses’ fear is only slightly that their jobs are on the line. Nurses will be required in whatever setting people obtain their care. No, it is far more a fear that no one recognizes that the value of the RN is the knowledge she or he brings to the bedside. The ability to assess, evaluate and intervene when things go wrong is the key to minimizing complications and, not uncommonly, to avoiding unnecessary disability or death.

Every nurse I know now says that she would not leave a seriously ill relative alone in the hospital anymore. How tragic! Do we know what we are doing to our health system in the name of economy? And then you, among others, say that the employee must, of necessity, shoulder more of the cost. More, I think, than you dream! And find another way to fund research? In your dreams!

PATRICIA A. FYLER

Brea