She Believes It Might Be Time to Rein in Managed Care

Re “Losing Patience” (July 9): It’s taken little more than 20 years for the insurance companies to regress to denying payment for so-called “cosmetic” procedures. In the late ‘70s, post-mastectomy reconstruction was not covered. Thanks to the crusading of Dr. Jack Fisher (then chief of plastic surgery at UC San Diego) and others, that changed. Is denial for breast reconstruction again on the horizon?

Our organization, as well as many others, sends teams of volunteer health professionals to Mexico and other countries to repair cleft lip and palate and burn deformities for children who might not otherwise receive care. Shall we set up volunteer charitable programs for children in the U.S. whose parents’ insurers deem the reconstruction of their birth defect ‘cosmetic”

Yes, health care is expensive today. And yes, there are more of us requiring care (and will be still more as boomers age). But perhaps you should have reprinted that L.A. Times article of a year or so ago on the compensation for CEOs and upper-level managers of HMOs and other third-party payers alongside your article citing care is denied because “there isn’t enough money to pay for everything.”

As I recall, many of those CEOs receive annual compensation of millions of dollars. And as I see in the Business section, shareholders in those same companies are getting rich as well. We are putting up with a new form of management-heavy bureaucracy (as we have in government and in education), but this time it’s killing us as well as robbing us.

When will we wake up to the current economics of managed care? When will we realize that health care managers are lining their pockets with dollars that should be paid to the health care providers to provide care? How many prescriptions will be denied aging women for osteoporosis preventive drugs before we start screaming? How many cataract surgeries will be denied patients who can no longer see to drive before we say “enough”?

KAREN S. MORGAN

Executive Director

Plastic Surgery Research Foundation

San Diego