Reactions to ‘HMO Backlash’
Your July 26-28 series on the HMO travesty to the health care system is very poignant--and I commend you wholeheartedly for your extensive coverage. You might note that the insurance industry is also deeply entrenched in the “mismanaged care” syndrome much like the HMO industry--just not quite as severely as the HMOs.
Unfortunately, it’s too late for many harmed individuals and practitioners, but maybe our health care system can be at least partially reclaimed.
As a pharmacist, I have been watching this tragedy developing for many years and I too have had to dis-enroll (or not even enroll) in the current managed-care mini-fiasco, and no longer take any HMO or insurance plan that subscribes to the below-cost reimbursement and dictatorial control (which is now virtually all of them) that you described in your articles.
Should you take a look at medication (pharmacy) issues involved in the third-party management of our system, you will find many similar cases as those you describe referring to doctors and hospitals.
For example: Why is the drug your doctor wants to use not payable? Why can you only go to certain pharmacies to get your medications? Why must you mail away for your medications (by requirement or by financial incentive) to a frequently out-of-state mail-order pharmacy where you never see, talk to or relate your current problems to the provider of those medications? Why are 40 pharmacies a week closing in this country? Why does it take 1 1/2 hours to fill your prescription? Why does a clerk-typist (with no educational requirements whatsoever) get the responsibility of reading your prescription, deciding what it means and what drug to use, the dose, strength and importance of drug-interaction information being spit out by the computer? Why do cash-paying, uninsured patients pay greatly exaggerated prices for their medications (in effect subsidizing the HMO-insurance industry)?
The answers reside in the same factors that are causing the problem with doctors and hospitals: control of the system by payers instead of practitioners (and with medications, the major drug companies play a role).
CURT DAVISON
Ventura
* Your article on physician-HMO contracts, although well-written, missed one critical point: HMOs induce doctors to aspire to mediocrity. The patients who are dissatisfied with mediocrity fight the HMOs. Therefore, the doctors who aspire to excellence, like Ken Saul, do not need HMO contracts to sustain their business.
If you spend five minutes in conversation with Dr. Saul--he gets it. He knows your family, he knows your child’s history and he behaves with accountability. He is actively listening and following the conversation. He does not waste 20 minutes trying to talk you out of your child’s symptoms or dismissing your concerns. He will briefly explain his diagnostic direction and as he’s walking out the door he will say, “If it’s not better in three days, call me.”
As a caregiver, you leave reassured that he hit the mark and there is no need to waste time calling back. Even if he seems hurried, you know the job is done and you don’t lament over every word he said for the next three days.
I suggest that it is not how much time a doctor spends with a patient; it is the efficiency of the care you receive during that time that is most critical.
This is where many doctors miss the target. A patient perceives the doctor doesn’t get all the information needed because the doctor seems preoccupied with getting him or her out of the office as quickly as possible.
If physicians paid attention to practicing exceptional medicine without gouging insurance companies or Medicare or covering for doctors who practice unethical medicine, maybe the paranoia would go away and the second-guessing from patients, HMOs and the government would go with it. That certainly would not solve our complicated “health care crisis” but it would be a healthy start.
LISHA SIMMONDS ZINDRICK
Thousand Oaks
* As always, sensationalism and selling newspapers is more important than getting the story from both side of an issue. Your contribution to HMO bashing will only contribute to continued overpriced, often unnecessary medical care, as well as unreasonably staggeringly high physician incomes.
The health care providers in this country have been allowed to practice expensive, often non-cost-effective medicine, overdoing practice habits and charging the consumer whatever traffic will bear. Someone has needed to tell the practitioner to look at what he / she is doing, and to practice cost-effective, quality, appropriate medical care.
Are you against this? Why not interview patients satisfied with good-quality, controlled-cost care. Go over to a Kaiser waiting room and interview the patients sitting there. Or go to a Kaiser hospital and talk to the patients in bed after surgery, or any consumers of an honest-provider HMO group instead of doctors unhappy because they can’t order all the medicines and tests they want to and charge the patient what they want to charge (and make less income, per your article).
Medicine is practiced by doctors, who should want to do the best that they honestly can for the patient. If they can’t or refuse to review their own practices, then someone may need to show them how this could be done.
Your articles pitting the patient against the HMO just create mistrust of honest practitioners and demand for unneeded medicines and procedures, and interfere with good quality medical care that is trying to be practiced by a doctor (like myself) who has practiced in the HMO environment 40 years.
HMOs don’t practice medicine, doctors do.
ALVIN A. MILLER, M.D.
Simi Valley
* Thank you for your long overdue discussion of medical care, specifically managed care.
Do you want affordable health insurance? Don’t buy fee-for-service. The insatiable appetite of the patient and the doctor has run amok.
Do you want a knowledgeable professional as your advocate? Don’t buy managed care.
Are you concerned about choice, cost and access to care? Then don’t buy socialized medicine.
Ask your doctor or health plan to get you a copy of the American Medical Assn. publication “Health Access America.” This plan to put the patient back in charge and reestablish the doctor-patient relationship has been on the books for more than five years. It’s time somebody listened.
RICHARD TUSHLA, M.D.
1985 President
Ventura County Medical Assn.
Santa Paula
