Aiming to Heal Managed Care
When Dr. Linda Peeno received an offer from Showtime about producing a movie chronicling her crusade to change health maintenance organizations, she didn’t return the cable network’s call. “I was really reluctant for a long time,” Peeno said.
Eventually, however, she realized a film could educate people about the managed care system and agreed to cooperate on the making of “Damaged Care,” premiering Sunday. Peeno hopes the movie will provide “a kind of systematic understanding that health care is not something we are going to fix with patient rights legislation. There are some fundamental questions we have to deal with and ask.”
Laura Dern stars as the doctor who spent several years in Kentucky raising her children before returning to the health care profession as a medical reviewer and director of two different managed care organizations. Not only did she find the work unrewarding, she bristled under decisions she had to make due to financial constraints.
Peeno discovered much to her dismay that her employers wanted her to reject nearly every claim, even if it was for necessary procedures. She reached the breaking point at one HMO, she said, when she denied a heart transplant due to fine print in the policy and the patient later died.
Peeno decided to leave the profession and has since become an outspoken advocate for patients’ rights, lecturing on the health care industry and testifying in medical court cases.
Dern sees Peeno as a true hero. “There is no greater theme to me in any movie than the everyman who is conquering the system or revealing the truth within their own nature or outside,” the actress said.
According to Peeno, some aspects of managed care have improved over the past decade, but others have gotten worse. “The public is knowledgeable now in contrast to the early ‘90s when I first started to speak out,” she said. “It’s amazing over the past four or five years the knowledge that people have.”
The bottom-line practices of the HMOs, though, have simply become more subtle, Peeno said, pushing decision-making down to the level of treating physicians.
“As soon as they start spending money on a patient--doing tests--that starts draining out the money they are getting,” Peeno said. “The sicker and more complicated a patient is, the more costly that is, so physicians start making decisions they wouldn’t make otherwise.”
A decade ago, Peeno said, physicians were more outspoken about these practices, but the economic realities have changed their tune. “If you are a young physician coming out of medical school with $150,000 worth of debt, maybe a couple of kids, you can’t simply afford ... to stand up against an entity on which your livelihood is going to depend,” she said.
“We have got to decide what we want medicine to be, how we want to be treated and how much it is going to cost us to do that.”
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“Damaged Care” can be seen Sunday night at 8 on Showtime. The network has rated it TV-PG (maybe unsuitable for young children).
