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Club Notice - 12/03/99 -- Vol. 18, No. 23
Table of Contents
Chair/Librarian: Mark Leeper, 732-817-5619, mleeper@lucent.com Factotum: Evelyn Leeper, 732-332-6218, eleeper@lucent.com Distinguished Heinlein Apologist: Rob Mitchell, robmitchell@lucent.com HO Chair Emeritus: John Jetzt, jetzt@lucent.com HO Librarian Emeritus: Nick Sauer, njs@lucent.com Back issues at http://www.geocities.com/evelynleeper. All material copyright by author unless otherwise noted.
Last week I said why I think that the Health Maintenance Organizations (or HMOs) were not just facing conflicts of interest, they really were in the conflict of interest business. Essentially they are able to turn a profit by the denying what is the best but also the most expensive health care.
I suppose originally HMOs saw the huge increase in medical spending, paid for in large part by corporate benefits packages, and they said they could help corporations manage the cost. Perhaps at one point it seemed like a good idea. But the HMOs threw themselves right in the middle of a situation where life and death decisions were being made and said that they could be trusted to make those decisions. For a money-making corporation to go into the life and death decision business sounds on the face of it to be foolhardy. And it really is. And it is particularly true in this litigious society. They would have to have a private army of lawyers to fight off the litigation and the inevitable bad publicity that they would be getting. Doctors make the same sort of decisions, but it is easier to trust a single person. It is difficult to trust the anonymity of a corporation and to know the corporation innately has to please its stockholders and to make a profit by saving on healthcare costs. The astronauts used to joke about how insecure they felt sitting on top of a rocket made of some huge number of parts, each provided by the lowest bidder. Anyone who gets his healthcare from an HMO knows how the astronaut felt.
The HMOs currently have immunity from patient and survivor lawsuits. Perhaps they should since juries are tending to give large awards when individuals sue large corporations. Juries also know the lawyers will take a large cut of the proceeds and they want some to be left over for the injured parties. Right now the laws mostly stand in the way of individuals suing their HMOs and the HMOs are generally protected by a somewhat sympathetic Congress. That cannot last. When the public starts to see their elected officials siding with the corporations against them, suddenly Congress will have a change of heart and suddenly being in the healthcare control business will become very much less profitable.
In the end I think people will realize that the HMOs are not an effective tool against higher medical costs. Sooner or later for the HMOs to avoid being stung to death by lawsuits they will probably be forced to make much the same set of decisions that personal doctors would have made and perhaps they will have to be even more liberal than private doctors would have been. Every decision they make that is more conservative than a private doctor would have made opens them up to the possibility of litigation. The cost of medicine will return to what it would have been without the HMOs PLUS the cost of more liberality to cover themselves PLUS the cost of the operating expenses of the HMO. The corporations will see that going with the HMOs was short-sighted. It was a short-term savings that will cost more in the long run. When that happens the same corporations that flocked to HMOs to save money will probably decide that health care is just too expensive a benefit. They will stop offering it altogether and perhaps the better companies will sweeten salaries a little, but not nearly enough to cover health care costs. Then we will find a lot of people just not able to get health care. Rather than forestalling that day the HMOs have hastened it. [-mrl]
The average dog is a nicer person than the average
person.
-- Andrew A. Rooney