The same type of doctors that ruined Fee for Service by overbilling and overtesting and bilking the insurance companies and Medicare are now working FOR the insurance companies as their CEO's and Medical Directors and bilking the rest of the population. Legions of clerical workers and "adjusters" are being taught to lie and distort the truth, anything to deny a claim, frustrate the claimant, and thereby increase company profits and their own bonuses. What they are doing is lying and distorting the truth for profit. In the law this is called FRAUD, but due to intense lobbying (which in the law would be called bribery), the regulatory agencies refuse to enforce the laws that would protect people against this pattern of fraud and abuse, otherwise known as racketeering.
Judy Morris, MD
I am fearful of this 1984, Aldous Huxley scenario. We are dehumanizing one of life's inevitable experiences. None of us is going to get out of this life alive and most of us will need some type of hospital care or important medical service. What the answer is to this dilemma seems to be that we again need to go to extremes to come back to the middle. In every historic change, this seems to be the case. The present era seems to be one of greed and immorality. Many people will have to suffer and families will have to react to watching loved ones die because of inhumane treatment.
I am finishing my residency this year and in comparing my first year and this last year of residency I can say that in the hospitals I have been there has been an increased emphasis in the bottomline. the nurse patient ratio as well as the resident patient ratio have both gone up, we see sicker patients, send patients home faster and try to manage patients on an outpatient basis as long as we can and everyday the the hospitals look for ways to cut costs (short staffing, decreased resident stipends, cheapo hospital supplies, paying for parking) pretty soon even the hospital staff will have to pay to work in the hospitals.
I work as a Nurse and have in the past two years really started feeling the impact of managed care. For example, I have insurance through an HMO that has decided midway through the year they would no longer accept the doctors that practice at the hospital where I work. I believe managed care doesn't really care about the patients or their well being but the bottom line on how much money they can make. The people making these decisions have no idea whats involved in taking care of critically ill patients just how can we do it cheaper. Our hospital is in the middle of trying to cut our budget signigicantly and in the process, I feel the care of the patient is ultimately what will be sacrificed. I realize health care is costly and there needs to be some changes but the cheapest way to do something isn't always the best. I also believe the public isn't fully aware of the managed care and money issues going on today and how this will affect them. This program was very insightful and showed very true issues involving health that were not biased. Hope you continue providing such programs.
Perhaps the public can now understand the despair that pervades medical practice today. The industrialization of medical practice corrupts the Hippocratic oath. What brought sadness to me was the tragic decision by the compassionate creative surgeon trained to help patients with birth defects to modify his practice to include a simple operation like liposuction. There is something wrong with a system that misuses its creative artists.
Rockville Centre, New York
The direction of health care today needs to take a lesson from the industrial revolution in the US and its failure to remember what created it. Demand for quality and value, unsurpassed for its desire to generate wealth for everyone, not just the privileged few. By allowing giants to take control, competition for precious dollars becomes non-existent and a monopoly that controls levels of care and costs with only the interest in profits the agenda. Shame on this country to dismantle a health care system that is the envy of the world. Only when it is broken beyond repair will the dreaded influence of the government come in and create the socialistic system sought by the current administration.
Where is Sherman Anti-trust when you need it?
San Antonio, TX
Managed care plans have a right to the fat, but not the muscle, bone nor sinew. If the matrices were turned I wonder how much fat could be squeezed out of managed care executives. Patients need to stay informed and demand the best service from both their health care providers and their managed care plans.
You were a bit naive in your questioning of physicians. These oh-so-concerned physicians have no problem flatly refusing to provide treatment a patient truly needs if he doesn't have the money to pay for it; it is hipocracy to claim they are any better than the insurance companies.
Doctors will always try to evade the real question: Do Americans have a right to a minimum standard of health care? If the answer is no, if a doctor isn't obligated to treat anyone with a real medical need, than they have nothing to complain about if an insurance company chooses to deny care.
On the other hand, if a person with a medical problem has any right to expect medically essential care, then we must provide it to all Americans. Doctors will tell you "medical care isn't a right, but that doesn't matter. Doctors give so much charity care there is no unmet need. And there's always the emergency room."
This is pure bull. I have been a practicing physician for 17 years. I work in an emergnecy room. Recently I saw a very nice woman of 62. She cound not afford medical care and had only come in because she was extremely weak. She had advanced breast cancer. It could have been cured had she had regular mamograms, as a wealthy woman would have received. Instead she will die. That is the system the AMA supports.
Physicians talk about concern for their patients, but take care of the poor when the law forces them to and not a second before. The term "charity" in medicine refers to the care physicians occasioonally deliver against their will to patients who can't pay, because of laws like the COBRA act that organized medicine vehemently opposed.
Why didn't you ask these doctors who do liposuctions and facelifts when they could be providing critical care: Why is money so important to you, when you could be helping people who desperately need it?
Maybe someday American physicians will really start caring about their patients, and support the universal health care taken for granted in all other industrialized countries. but don't hold your breath.
Merritt Island, FL
Managed care does not reduce the prices of health care, only the number of treatments. The real problem is the blank check our private system offers doctors, drug companies, laboratories, hospital administrators, HMO administrators, insurance company executives, etc. Aids drugs, for example, are priced at $20,000 per patient year, but only the patent holders knows how much they really cost.
Physicians pleading with HMOs are not pleading for their patients, they are pleading for their own fees.
Until we have a national health service in which all the players are salaried civil servants, the price of medical technology will continue to be greatly in excess of its cost.
Managed care is and was the inevitable and necessary reaction of an American health system which grew up in a disjointed,unplanned way. In order to allocate medical resources health care needs to be delivered in a system which seeks to conserve those resources and give people the appropriate level of care to meet their need. Historically we have had a wasteful system which acted as if those resouces were unlimited. Do we want our health care system to consume even more of the GNP than the 12% in already consumes. We needn't bemoan the plight of the hospital - it is an institution which is evolving to meet the realities of the maketplace.
A. Lee Conrad
As a professional healthcare manager, I do not know how much longer there will be professional healthcare. The surgeon by which I am employed works longer days with lower income. Much of his work, he does for free because many of our breast cancer patients need immediate reconstruction; and approval by the managed care insurance companies does not always come in time before the patient's surgery.
In January of 1997, my employer, Dr. X, performed breast reconstruction on the patient's left breast and a mastopexy on the patient's right breast so that the patient's breasts would be symetrical (Dx breast Ca). Even though a State law went into effect requiring insurance companies to cover the non-diseased breast, payment was denied. The insurance company stated that at the time of surgery, it did not apply to this woman because she was employed by a "small business". This woman is now responsible for the outstanding debt.
I find it overwhelming that our patients must deal with the burden of cancer and at the same time, fight insurance companies. how can a patient heal when they have to be defensive?
Americans are going to have to decide where their healthcare falls in life's priorities. As long as showing a profit competes directly with providing good healthcare, one or the other must suffer. As it stands today, profits for the insurance companie's stockholders outweighs the importance of the human condition.
Finally, I would like to wish the best for Dr. Hasan and hope that if he ever is in need of medical care that he doesn't have insurance through his company. His quote about the best quality care for the lowest cost should have been stated that it is all the care that we can provide for the little amount we're going to pay.
Generally well done! But, I always have a "but", the program didnt address the main issue. What is "quality care"?? There were several opinions from nurses and doctors but there wasnt enough information to help anyone answer that question. Surely there needs to be some organization to tackle the question head on. Perhaps its Arthur Miller, or a panel of ordinary citizens. I hope it isnt a branch of government, they only make a worse mess of things.
I agree with the nurse who said that she needs some time just to hold a paitients hand. But I also know that the same nurses want to make very high salaries which makes it too expensive to have them spending much time holding patients hands. Perhaps the medical proffessionals should be offered a choice:
A) Handle a fast paced , stressful assignment and be paid more or B) Take a less hectic assignment and be paid less.
Your program spent quite a lot of time with hospital administrators. They spoke often of how much a nurse costs. But they are paid a lot more and their responsiblities are no more demanding than similar postions in business and industry which are paid much less. Rather than focus on the nurses alone, you should give us some information on non medical costs in hospitals compared toi other businesses.
Other factors you ignored are; 1)the very high prices doctors charge,2) the portion of hospital expenses for caring for the indegnet patients tacked on to hospital bills ( and in turn, HMO charges), and 3) the comparative success of well run, non profit HMO's.
Good start, but we need more. Especially a national debate to define "quality care".
I work for an HMO, my wife is a Registered Nurse. I feel your program provided a balanced view of the situation without going to emotional extremes of all the parties involved. My wife was working this evening and I taped the program. This looks like it will generate many hours of discussions of the morality, ethics and goals of our health care system.
Some items left out of the show were : - the impact of lawyers and lack of legal reform in regards to the cost of health care malpractice - the impact and liability of failing HMO's (i.e. Oxford Healthcare) on the diminished capacity of a strained medical delivery system - the federal goverments efforts to migrate medicare and medicaid patients to HMO roles to control health care costs - the upcoming crisis and cost of the Year 2000 issues - the impact to nursing homes and the potential impact of an aging baby boom with high expectations
I look forward to additional Frontline programs on this issue. Thanks
My concern is that we as citizens are becoming slaves of our institutions. Institutions which were created to serve us now make us serve those who manage them, their top managers and their boards of directors all with controlling interests. Unlike the nurse who said she doesn't think the public recognizes the service degradation occurring in the medical system I think we are aware of not knowing how to counteract it.
Life is already so demanding, so complex, so draining that even if we knew what would improve health care, we feel overwhelmed.
We have inherited an economic system that is completely out of balance, and we must counter it. Otherwise, we will perish in civil unrest and dysfunction. U.S.Capitalism is an evil unless it is made democratic. Right now, it is totalitarian for citizens who are human beings rather than consumers.
Chapel Hill, North Carolina
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