Using HMOs to Control Medicare Growth

Re “2010 Will Be Too Late to Reform,” Commentary, March 12: The Times has once again presented the theory of Alain Enthoven and Sara Singer that the answer to controlling health care costs lies in placing everyone in HMOs, which then compete in the marketplace. This concept has already been thoroughly tested in California.

There has been about a 30% reduction of medical services provided by HMOs, but almost all of this savings has been retained by the managed care industry. In fact, in our mature managed care market, overall health care costs continue to increase at greater than the rate of inflation. As a cost control measure, the competing HMO theory has been a failure.

The HMO takeover has been very destructive. Patients have lost choice in health care. The physician has been placed in an adversarial relationship with his own patient, in order to assure his own financial success. Quality can never reign in a market with such perverse incentives and controls.

With the current level of health care spending, 14% of our GDP, we can provide quality care for everyone in our nation. Through more altruistic health care economic models, we can have effective cost control, while still supporting a system in which we preserve patient choice and provide incentives for physicians to advocate exclusively for quality care for patients. We must dump the perverse HMO model and move on with real health care reform for America.

DON R. McCANNE MD

San Clemente

The authors state that “Medicare HMOs offer more benefits than Medicare . . . at less cost.” This assertion is simplistic. While it is true that Medicare HMOs pay for many medications for their recipients and also provide many well-patient benefits, Medicare HMOs glaringly do not provide the specialized care that many of their frail elderly recipients require.

As geriatric case managers in Los Angeles, my colleagues and I visit numerous clients who are generally in their 80s and 90s, have multiple health problems including dementia and other psychiatric problems, and are homebound. Most live at poverty level. Many have Medicare HMOs. Many have no families who can advocate for them in the HMO system. We have generally found that HMOs are ill-equipped to take care of these clients. They do not have trained geriatricians and they do not provide treatment models that take into account the physical and mental frailty of these clients.

While I agree that Medicare needs to be fixed, trying to fix Medicare at the expense of helpless people who need appropriate medical care shames all of us.

PAULA FERN

Santa Monica