Commissie de Vries

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Minister Borst laat haar misschien door de systemen in andere landen
inspireren. Gisteren las ik een commerciële recensie van een boek waarin
bepaalde aspecten van het Amerikaanse systeem beschreven worden. Het blijkt
dat winst belangrijker dan het leven van de mens gaat worden. Op de recensie

rusten geen auteursrechten en iedereen mocht het verspreiden:

Your HMO: Guardian of Health or Profit?
HMOs and managed care efficiently use health care resources to save patients

money on premiums. Doctors are happier, patients are healthier. Greed by the

new giants of health care is strictly curtailed by the ever-present threat
of
patient lawsuits should anything go wrong. And doctors are fierce advocates
for their patients' needs, guaranteeing good care. It's a good thing
Congress
didn't succeed in creating cumbersome regulations for the industry in the
summer of 1999.
That's the image. And HMOs certainly have been efficient--for the executives

who profit from them. Consider these pay packages for top execs of HMO and
managed care companies, as detailed in Jamie Court and Francis Smith's
"Making
a Killing: HMOs and the Threat to Your Health."
*Malik Hassan, CEO of Foundation, made $17.2 million in 1996 with stock in
1997 worth $166.4 million;
*William McGuire, CEO of United Healthcare, made $14.7 million in 1996 with
1997 stock worth $74.7 million;
*Leonard Shaeffer, CEO of Wellpoint, made $14.2 million in 1996 with $16.5
million in stock in 1997.
Court and Smith list ten other robber barons of health care whose stock
options are in the millions and tens of millions. When mergers happen, they
make more: former U.S. Healthcare CEO Leonard Abramson, now on the board of
Aetna, made nearly $920 million when U.S. Healthcare was acquired by Aetna!
These hundreds of millions of dollars could have been used for health care.
And HMOs have certainly proven popular--with employers who often foot some
or
most of the premium costs: Just one company, the newly combined Aetna and
Prudential, will insure one out of every ten Americans.
Meanwhile, the quality of health care provided is dropping, not rising.
Recent
statistics are alarming:
* HMO patients are 59% more likely to have problems getting treatment than
those who have health insurance not tied to an HMO;
* HMO patients over 65 are 93% more likely to have worse outcomes than
fee-for-service patients;
These problems are so prevalent that:
* 55% of Americans fear that when they are sick their HMO will be more
interested in saving money than providing the best medical care;
* 48% of all Americans say they know someone who has trouble with their HMO
including getting referred to a specialist or getting the HMO to pay an
emergency room bill.
Cutbacks in care to boost the bottom line have changed the doctor-patient
relationship. Doctors' decisions on what care is appropriate are now
reviewed,
and often vetoed, at the HMO's head office by bureaucrats--who never see the

patient. One example comes from Dr. Linda Peeno, who testified to Congress,
"In the spring of 1987, as a physician, I caused the death of a man I saved
[Blue Cross/Blue Shield] a half a million dollars The decision about the
California patient [in need of a heart transplant] was made from the 23rd
floor of a marble building in Louisville, Kentucky," she added.
Despite burgeoning marketing budgets like the $61 million spent by Kaiser
Permanente in 1996 for billboards and TV ads full of smiling patients and
doctors, physicians are frustrated with the constraints on providing that
care. A 1997 internal Kaiser survey of doctors found average physician
morale,
rated on a scale of 0 to 10 (10 = excellent), to be just a 2.
Worse, doctors often suffer financial penalties for providing treatment, and

are rewarded when the care they mete out is kept within harsh budgets. This
untenable situation led Doctor Daniel Fisher to write his 2,651 patients:
"As
of 7/1/98 I am quitting the practice of medicine. The system of HMOs,
managed
care, restricted hospitals and denial of needed medication has become so
corrupt that I cannot stomach it any longer."
The realities for patients are often grim. When David Goodrich, a deputy
district attorney in California, became stricken with cancer, HMO delays of
critical care became so acute that his doctors had to administer care
without
corporate approval. It was too late: cancer that might have been halted in
time had spread, and he died. His wife, Teresa, won $120 million, the
largest
verdict ever against an HMO.
Scores more patients might be called fatalities for profit. Like a little
boy,
Chad Aitken, who died after having a reaction to a vaccination, and being
denied treatment. Or Betty Hale: denied a bone marrow transplant by Blue
Shield, and determined to start treatment, she was forced to raise $30,000
by
selling handicrafts she made. She survived and, thanks to her doctors, is
cancer free. But she still owes the hospital $184,000.
Now get this: unless you are a government employee like David Goodrich, when

you sign up for an HMO, you sign away your right to sue. Instead, you get
arbitration of disputes. The system is rigged in the HMO's favor: first, the

arbitrators depend on HMOs for business, and so have a vested interest in
siding with them. Second, HMOs delay the process; critically ill patients
often die before their cases are resolved. Finally, under most arrangements,

HMOs can only be forced to provide the care that has been denied, and no
punitive or other damages are awarded.
The Congressional Budget Office has estimated that giving patients the right

to sue would add only 1.2 percent to the cost of health-care premiums.
The system is so rigged that in 1998, the nation's largest association of
arbitrators joined with the American Bar Association and the American
Medical
Association to condemn the forum of arbitration for health disputes. The HMO

response: just hire different arbitrators.