Last year the Congress failed to act in spite of the need for national health-care reform. But the furor caused a modest fall in the rate of increase in national health-care costs from 10 to 11 per cent to 8 percent for 1994. This has happened before. In 1984 Ronald Reagan solemnly pronounced that “the back of health-care inflation has been broken.” However, the drive for superprofits soon reasserted itself, as everyone knows. Now the new slogan is “The Health Maintenance Organization (HMO) will save the day!”
Alan Rosenberg, an HMO representative, unashamedly repeated this opinion (Voice, July 12). But Bruce Vladeck, head of the Federal Health Care Financing Administration, reported on Dec. 24, 1993, that Medicare would stop pushing patients to enter HMO’s because there was little evidence that costs were lowered. A government-authorized study done by Mathematica Policy Research, as reported in the New York Times of Dec. 27, 1993, said: “The government had paid 5.7 percent more for Medicare patients in HMO’s than it would have paid if those people had been in the regular Medicare program. Medicare is not achieving its goal to save money through HMO’s.”
On the issue of quality and patient satisfaction, the jury must be considered as still “out.”
HMO’s operate like “company doctors” in that physicians and other providers are employees of and owe first commitment to the insurance company/HMO. Patients are usually ignorant of the pressures to which HMO physicians are subjected. HMO physicians have to make medical decisions fully knowing that “Big Brother” is monitoring their patient-time, hospitalization rate, length of stay, number of consultations ordered and the cost each physician runs up with prescribed drugs and services. Cash bonuses are awarded for compliance.
Given this environment, there has to be a dissociation between patient satisfaction and good medical practice. The sad truth is that many “satisfied” HMO patients may be under poor medical management and never know it.
