Dueling Twins

HMO

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The 'Dueling Twins'

In medicine sins of commission are mortal, sins of omission are venial.

Theodore Tronchin

Counterpoint:

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Managed Healthcare Is Bad For Your Health

by James Hall, from the Left

Our ancestors were on their own when it came to their health. Then came medicine, doctors, and hospitals and they had expert partners assisting them and if they didn't like their doctor or local hospital, they could choose others. Then came modern managed care, and now--ironically--we're back on our own once again. That's because your doctor and hospital are forced to take orders from the insurance industry, and that industry is chiefly concerned with making a profit on your health. This they do by limiting your options on the number and kind of doctor's visits, tests, and treatments that might be costly to them but that were designed to cure you first and worry about the cost later.

All this comes about as a result of the wrong-headed idea that any system privatized is a better system. In this case we've taken a medical system--once the finest in the world--where the priority was good health at any cost and turned it into a system where good health becomes another cost in a system designed to minimize costs and maximize profits for the insurance industry and its shareholders. The system works wonderfully for those shareholders--so long as they themselves don't have to rely on its healthcare products.

If you want to know just how badly healthcare is doing these days, talk to doctors swarmed under with paperwork justifying to insurers every minute they spend examining you and every nickel they spend on you. Talk to hospital administrators shortchanged on insurance payments who must cut back on hospital services and qualified staff. Talk to underpaid, undertrained and overworked nurses--their occupational injury rates today are on a par with construction workers. Or worse, try getting sick and you'll find out just how limited your treatment options are. Under managed care you put yourself completely in the hands of an industry that sees you as a cost, to be treated as cheaply and discharged as quickly as possible.

The only way to get relief from managed healthcare's domination by the insurance industry is through legislation giving patients, doctors, and hospitals legal protections. And the healthcare industry, realizing this itself, has spent billions of dollars on lobbyists and political contributions. Their latest target is a patient bill of rights now passing through Congress which would permit poorly served patients or their survivors to sue for damages and deaths based on the industry's denial of necessary treatments.

The Bush administration and the healthcare industry supports a watered-down version of the bill that would permit patients to sue only in federal courts, where the waits are longer and monetary awards are usually far less than on the state level. It makes far more sense to permit patients to sue on the state level, where insurance companies face regulation by state governments, and where many patients enjoy rights created by state law. But this is one area where the Bush people have abandoned their ideological concern with states' rights and local control for the support of big money corporate donations.

Do we really want our medical decisions made by our doctors or by corporate beancounters? Do we want our hospitals slowly starved out of existence and do we want nursing to become all but extinct? If so, we have only to continue to give insurance companies free rein in dictating the healthcare that professionals can give us. Otherwise we should support legislative initiatives that hold insurance companies accountable for their actions and those that let our healthcare professionals make the important decisions that literally mean the difference between life and death.

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Final Word:

Even my namesake on the Right gets it correct once in a blue moon--or is it in a blue cross and shield? Nonprofit HMOs and insurance companies are the way to go--I belong to one myself. But there's still more than can be done than simply opting out of medical insurance policies designed to make a profit for someone else.

Americans now have an opportunity to choose what kind of patients' bill of rights they want to regulate their medical treatment. Two very different bills are before the House of Representatives. One, the bipartisan Dingall-Norwood Bill, gives ordinary citizens the right to sue in the event of an HMO-caused malpractice in their local state court system. It permits awards of up to $5 million dollars for pain and suffering and even punitive damages. The second bill, the Fletcher Bill, would force plaintiffs to file lawsuits only in federal courts, some of them distant from a patient's home, and would reduce amounts patients could sue for by 90%, to half a million dollars, and would prohibit juries from awarding punitive damages to careless and heartless HMOs.

It doesn't take a brain surgeon to guess which bill the HMO industry is backing. President Bush also backs the industry-friendly Fletcher Bill. As governor in Texas, he tried to block a state patients' bill of rights and reluctantly let it become law when it passed the Texas Legislature by a veto-proof margin. Dingall-Norwood has already been passed in the Senate, and Bush has threatened a veto of it should it arrive at his desk. He's also trying to negotiate with Republican sponsor Rep. Charley Norwood to water down the punitive elements of the bill.

Without the credible threat of lawsuits, the HMO industry will continue to treat patients as costs, not as people. If enough people support Dingall-Norwood as it is, it won't matter whether President Bush signs on or not. Contact your Congressman and tell him to vote for Dingall-Norwood.

James Hall, From the Left

Point:

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HMO = Have More Ordure

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The subject of medical reform and HMO's is one area where people of 'good will' can have valid differences. But those views may still not provide the solution that seems so illusive to develop. Profit is good in business. But is medicine really a business and should the normal rules of the market apply in the same manner? Current legislation avoids the central issues. Let us agree that the goal is quality of service, proven methods of diagnosis and treatment, value in costs, and widespread availability. A single payer system can never satisfy these requirements. A lesson from another era, seems to have been lost, and may well be the cure we are looking for.
A physician has traditionally been in practice as an independent venture. Pay for service, supplemented with individual insurance was the standard. HMO's developed out of a need to curb spiraling costs and were formed as profit centers. Most businessmen dread administrative duties. In medicine these functions can drain more time and energy away from the real purpose of the practice. Therefore, it was not a tough sale to get the HMO concept going. The promises for efficiencies have now turned into horror stories of decisions by the numbers. What went wrong is not the issue. What has a chance to provide a solution, needs to be the debate.

Hospitals were once the pride of the community. All too often they are now in receivership. Real costs to the patients have gone through the roof, while quality often suffers. Even with all these shortcomings, most of the rest of the world views medicine in America as some of the best available treatment. Years of quotas, second rate equipment and short staffing has proven that the socialized bureaucratic formula has failed. The HMO hybrid has collapsed in its own way, as well; and no government agency will be the answer. The path to wellness is the way of the past, modified with current innovations.

Medicine should be part of the merchant class model. Accountability for malpractice must remain a real liability to protect the patient. According to the US Dept. of Health & Human Services there are 700,000 physicians in the US. Accidental deaths caused by physicians per year are 120,000. Not every death is malpractice but many are. Instead of insurance companies providing coverage of liability, the doctor should self insure with a portion of that accrued risk being born by the patients who are receiving the service. Any law suit that fails to prove a violation of intentional malpractice, would need to be financially withstood; personally, by the lawyer who lost.

Medical coverage is NOT a right, nor is it free. Those who lavish universal application for services are forging a society that requires coercion for compliance. The costs of any function needs a payment. When government deems that the public welfare justifies contributions from all for the use of some, you lose your freedom. Individuals have the responsibility to make their own way in this world. There are no guarantees that can realistically be expected, nor should there be one.

If doctors want to enter into arrangements for lab services or administration maintenance, that is fine. But the financial relationship between the patience and the physician must be kept as much as the accountability of the doctor for his healing skills. Neither a profit corporation, nor a non profit institution, or a government agency can ever deliver the high quality of medical care that individuals can do for each other.

The most unfortunate have always relied upon charity for their care. Attempts to bureaucratize coverage for all is a cure worse than any disease. Technology has extended the length of lives, but has seldom enhance the quality of their life, alone. Current proposals to alter the HMO dilemma are all adjustments to a flawed system. The political realities will work against a sensible design of a medical system. As long as this is the case, take you own medicine; your care may well be better at home than in the asylum, known as health care. Freedom is NOT maintenance-free!

James Hall aka SARTRE

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Rebuttal:

Well James is not as ill as usual. He must be taking his medication lately and is currently stabilized. Since his remarks are sensible, we should agree that the doctor has the primary responsibility for the treatment with his patients. But patients also share in the their own good health. Where this debate jumps the track is when people insist that the government must enter into this relationship. If people are sincere in correcting the medical system, let's restore the doctor/patient relationship.

But experience suggests that just the opposite will happen with the proposed legislation before Congress. No doubt that the insurance industry has interests quite different from meaningful reform. And only the most foolish would think that the political contributions of the HMO lobby will not be reflected in any legislation. The profits that HMO accrue exist because the physicians voluntarily relinquished control over there business. Now that this genie is out of the bottle, the cure may require extraordinary measures. Yes, legislation will be needed, but the crucial question is proposing the correct reform.

Here again the people know that the system is broken, but few are willing to demand a solution that will actually benefit their real interests. Medical care is an issue that has the greatest significance for all of us. The next time that proposals for a complete government monopoly are made, Senator Phil Graham may not be around to derail the socialized approach. A sensible approach would be to convert the HMO from private corporate organization to a system of non-profit patient owned insurance. Couple this with the legal reform to discourage frivolous malpractice suits and uniformed pricing on pharmaceutical prescriptions, and you just might have a chance to revive heath back into the system. Beware of politicians who attempt to make partisan advantage on this issue, for they are the most dangerous sickness that will prove to be terminal to the health of all of us.

James Hall - 'The Right'


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We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.

Elisabeth KüBler-Ross

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