HMOs and Medicare
I find it highly ironic that The Times extols the virtues of Medicare HMOs in the fight to reform Medicare (editorial, Feb. 24). You cite awareness of “dangerous drug combinations” and focused spending on “the most cost-effective” treatments. On the same day, you report in Business that PacifiCare, the nation’s biggest Medicare HMO, has tripled its profits by dumping “unprofitable markets” of Medicare beneficiaries.
To call fee-for-service “outdated” is wrong and harmful. To my mind, fee-for-service means patients can choose a personal physician to act on their behalf (not X number of “covered lives”), to help choose “their best” treatment (not just the cheapest) and help them choose where and when to spend their money (as opposed to a committee of bean counters).
In my Westside private practice, patients are bright, inquisitive and frugal in their medical decision-making. They know I’m working with them and for them. For The Times to assume that the rest of the nation is less deserving or intelligent is quite condescending. Be careful what you wish for.
M.J. KELLY MD
Santa Monica
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Your editorial snidely comments that when the fiscal problems facing Medicare became apparent, “Congress promptly did what it does so well. It appointed a 17-member commission.” Actually, more than a year earlier, Congress had passed legislation to strengthen the system’s financial position by introducing competition and encouraging beneficiaries to move away from fee-for-service plans. And it would have become law, too, if the president hadn’t decided it was more politically convenient to scare the pants off old people than to help fix a system that benefits them.
You also claim that Sen. John Breaux’s (D-La.) plan to move toward market competition in provision of Medicare services “lacks safeguards to discourage HMOs from . . . denying patients medically necessary care.” Elderly Americans are perfectly capable of evaluating evidence about the merits of various health care providers, and there are numerous private and public organizations (AARP, for instance) in a position to help collect and disseminate such information.
BOB CARRICO
Costa Mesa