TIME MAGAZINE asks: HMO's? NO! * TIME MAGAZINE (Jan.
22, 1996) contained an excellent article on HMO's that should be read by all.
The following is an editorial comment on that article.
* TO THE EDITOR:- Your article, "The Soul of an HMO" (TIME:
Jan.22,1996) reveals some important problems with managed care in the United
These have developed because of interference with medical practice and
economics by policymakers and social engineers. Most physicians have been aware
of these problems for a long time, but they have been afraid to speak out
against them for fear that they might lose their livelihoods.
Thus social and governmental pressures have served to undermine the ethics
that have been part of the bedrock of American medicine. Once health care
planners successfully switched the American public from thinking of their
individual health care needs and responsibilities to a mindset of "our
needs", "our health care dollars", "providers" instead
of doctors and the like, such an outcome became inevitable.
I hope, however, that it is not irreversible. In 1994, after 23 years as a
practicing Obstetrician-Gynecologist in Fairfield CT, I concluded that I could
not practice in an ethical manner in a managed care environment and I closed my
In the letter that I sent out to my patients notifying them of my decision I
said in part, "...The truth of the matter is that the economic and
regulatory climate in which medicine must now be practiced has made my
personalized style and type of practice, in which I take great pride, extremely
Employers shift their workers (my patients) around from doctor to doctor,
thinking only of how "cheap" a group insurance plan is and giving no
thought at all to the physician-patient relationship.
Insurance companies appropriate to themselves, under the guise of the term "managed
care", the right to refuse necessary care to patients in order to enhance
their own profits.
Medically untrained lay persons, reading words they cannot pronounce from
pre-programmed computer screens, tell physicians how to practice medicine..."
These words continue to ring true every day, and the situation is getting worse.
Committees such as you describe in your article meet daily at managed care
firms and make decisions such as: a) patients over age 72 are "too old"
to qualify for coronary bypass surgery; b) aggressive cancer chemotherapy is "not
economically justifiable" in patients over age 75.
Are these the proper criteria on which to base an individuals health care?
I certainly don't think so. I believe that this is contrary to the very basis of
American liberty and individualism.
Unfortunately, there is nothing new about managed care, managed competition,
managed trade, or any other such policy-wonk creation. It is called Corporatism.
In a bygone era it would have been called Fascism, but that term has become so
associated with racial/ethnic hatred that most people forget that the underlying
concepts of fascism were first and foremost economic. It is "the other
As Americans we have become so inured to the canards of "the left"
and "the right" (taken from the seating in the French Assembly) that
we forget that economically and politically, Fascism and Communism are not
opposites but are in fact, merely variations on the same theme of governmental
control of the citizenry and its business.
If this is allowed to continue American physicians will eventually be called
upon to decide which patients are "worthy of treatment, given our limited
economic resources". This is completely contrary to traditional American
Fifty years ago we successfully fought a war to once and for all do away
with the concept that some groups of people are "lebensunwertes Leben"
- life unworthy of life itself. Let us not now bring these horrible, discredited
concepts of economic "efficiency" to this country! Physicians now face
a crossroads similar to that faced by the French after their country was overrun
by Germany in W.W.II - where does appeasement end and collaboration begin?
For a doctor to join a small number of managed care plans in order to
enhance the survival of his practice until things can be fixed is probably
acceptable, even necessary, in today's climate. But to join as many plans as a
doctor can get into, to accept whatever reimbursement is offered by the managed
care firm without thought to the effort and resources expended, and to fail to
defend a patient's right to the best possible care because a doctor is fearful
of being "deselected" from the companies provider panel is inexcusable
Sadly, even the AMA stands on the threshold of crossing the line. We stand
at a dangerous crossroad in American medicine today. Let us not cross over the
threshold into unethical and inhumane care.