Getting Good Care Is All Up to You
Anyone interested in a broad view of the woes facing the American health care system would come away well-informed, if not depressed, after reading these three new books. Each, in a different way, arrives at the same bottom line: You are responsible for your own success or failure in navigating today’s health care system. No one--not your doctor, hospital, government representative, insurer--is looking out for you.
An interesting account of the breakdown of the fee-for-service medical system can be found in Dr. Michael E. Makover’s “Mismanaged Care.” Makover, an assistant clinical professor at New York University, argues that managed care is a disaster and cannot succeed. The shift to for-profit HMOs, he says, works by preserving corporate profits while taking money from doctors (by forcing them to charge lower fees) and from consumers (through higher out-of-pocket costs and reduced care).
Overtly pro-physician, Makover investigates the failure of the Clinton health care reform plan, saying that it erred badly by not having a single practicing physician advisor or any “ordinary people” on its 500-person reform panel.
Makover predicts the ultimate failure of managed care because we “can’t have both good care and low-cost care” at the same time. Instead, he advocates a return to fee-for-service medicine with the use of medical savings accounts for those who can afford to contribute to them. This system would be bolstered by catastrophic health insurance for everyone, administered by a nonprofit group, and a government-subsidized medical savings account for the poor.
While Makover’s book provides food for thought on the past and future health care system, Dr. Bruce Barron’s “Outsmarting Managed Care” offers ideas for getting good care in the current system. Barron has worked as both a practicing doctor and an HMO executive, and one would perhaps expect more from him on the real inner workings of HMOs. The book doesn’t provide that but does offer a thorough job of pointing out the many pitfalls consumers face. He offers some good advice on how to get the best care, including the tip that you’ll fare best if you have a doctor who will fight the HMO on your behalf.
Barron also notes how the medical system is lax in allowing inferior doctors to practice medicine. That fact is no clearer than in James B. Stewart’s “Blind Eye.”
Stewart tells the story of Dr. Michael Swango, who, the FBI believes, is a prolific serial killer who took the lives of as many as 60 patients while in charge of their hospital care. It’s a dramatic story, and readers will be appalled at how the medical system refused to deal with Swango--who was convicted on some charges and is now in prison--long after suspicions about him were raised. Stewart demonstrates that the medical profession has no aggressive measures--and no intent--to root evil, or even incompetent doctors, from its ranks.
