The High Price of Health
Viewer Reaction

What are your views on managed care and the problems of money and medicine?

Dear FRONTLINE,

Patients are inconvenienced, dehumanized, prematurely discharged from the hospital, suffering and sometimes dying.......all under the guise of efficiency. In truth, this is efficiency for the HMO (EFFICIENCY=GREATER AND GREATER PROFIT FOR THE HMO,THE CEO AND THE INVESTOR). The HMO CEOs of the world serve themselves and their pocketbooks only.

Originally the HMO concept was a sound one but is has been bastardized to be strictly a revenue producer. Generally speaking, the HMO serves no useful purpose for society. It intrudes between doctor and patient, and between hospital and patient, always seeking to reduce its "medical loss ratio" [money spent to take care of the patient], all the while immediately taking its unearned 30% profit off the top. The HMOs have cleverly placed themselves in this position with their monstrously expensive advertising programs, promising the subscribers everything they need for health and promising the employers(sometimes the providers of employee health coverage) reductions in health care coverage cost. This is how they have wedged themselves into a position they have no moral right to occupy. They will remain there until subscribers finally say "no more" and employees say to their employers "I will not accept this....you must give me real health coverage" More and more patients are suing the HMOs and seeking state regulatory help in combatting widespread abuses and breaches of contract by their HMOs.

Hollywood, Fl

Dear FRONTLINE,

Your piece on managed care was like watching a funeral procession. What about the consumer response? What about the legislation pending on managed care control? What about the alternatives? I am a psychologist and we have been making some minor changes in mental health services, e.g., parity with medical services in regards to lifetime service costs. In NY we were effective in having a mental health bill of rights passed which affords the consumer increased access to choices and appeals. Hospitals are also starting to join together to form their own insurance networks. In Philadelphia I understand that the Medicaid managed care contract was taken over by the city on a non-profit basis with any profits going back to services in the city. We should rally the consumer and support the provider rather than just roll over and die (while waiting for an approval from a case manager, most likely). Please provide a look at these issues for it is from hope that change usually comes. Thank you.

katonah, ny

Dear FRONTLINE,

An attempt to rein in costs while shaping health care to needs of the public and changes in technology was not mentioned. That was the health-planning movement based on government mechanisms. It was not successful, mainly for political reasons. I served on a health planning advisory board for Montgomery County, Md., in the 1970s. The health professional establishment, including hospitals, resisted consumer representatives; they held power closely and preferred to go the back political route through cronies in government. In place of collaboration with consumers, the health field is under the boot of the marketplace, or those that say what the marketplace needs. The program should have mentioned this history. Our country may yet move into a highly regulatory environment for HMOs, with, I hope, heavy consumer representation and a climate of collaboration.

Mal Schechter
mschecht@aol.com
New York, NY

Dear FRONTLINE,

Thank you for an excellent program. Only when the average American becomes aware of the "costs" of making health care a "for-profit" [isn't that an oxymoron?]business, will the values which make healing possible to brought back into health care. Human connection is the primary agent in effective health care. It is particularly sad, and perhaps only a little less frightening, to see how managed care is destroying mental health care. In that particular instance the relationship between healer and patient IS the healing agent. By reducing it to automobile assembly line!!!!! (as if one therapist and one patient were interchangeable with any other,) we have not only demonstrated our total ignorance of human beings and mental health care, we have simultaneously destroyed one of the most valuable things our increasingly "mechanistically endangered" society has managed to maintain. And Outpatient mental health a part of society which DID NOT add to increasing health care costs. Please keep up your good work of exposing the public to the truth - and the truth to the public. In my humble opinion, these people who equate health care with assembly line production should hang their heads in shame. People who know the cost of everything and the value of nothing. There are ways of ending the excesses of one era without resorting to the opposite Draconian excesses of the total opposite. I would only suspect that when Mr. Malik Hasan needs his heart bypass surgery, he will rely on his billions to procure the most experienced surgeon to perform such an operation. I somehow feel absolutely sure he will not be content to let some clerk reading from a manual decide whether he should [as a cost-effectived measure] have the surgery, and if so, who the surgeon should be. I can only hope he would be so wise should he succumb to a Major Depression or one of the other major mental illnesses. I will go so far as to venture that should his teenage child need outpatient mental health treatment, he would be well-advised to secure the assistance of someone whom one of their peers had found to most effective, rather than relying on which practitioner was willing to accept his cut-rate bargain basement prices and end up on the list of "approved providers." The best practitioners do not have to do this. People will pay their own money to see them - because they value their health care - including their mental health care.

Mary Kilburn
marykilburn@mindspring.com
Raleigh, North Carolina

Dear FRONTLINE,

I'm a fair weather viewer of PBS but this story had me glued to the TV. I'm a non-practicing RN @ present with 15yrs surgical ICU experience. Vt. nurses are voicing identical concerns as those in Mass. and Ca. Lowest morale ever, not enough staff, senior staff are being offered/encouraged to take early retirement pkgs (saves dept $), and patients are at extreme risk. Like the RN from Ma who left hospital and started working in ER clinic, she'd go home every night and wonder what she might have missed,etc.The gentleman who cared for his wife's leg ulcers at home was another good example of how there is too much burden being placed on the lay person. He even said something about mastectomy patients having a 1-2 night hosp. stay. My brother-in-law's mother just experienced this very thing in N.J. last wk when they wanted her out in a day! She's 75yrs old. Who does all the follow up? Are they in and out in an hour? The system is pathetic.I agree in cutting costs ie. supplies, but you need nurses!

Linda Wurth
chatham@together.net
Richmond, Vt.

Dear FRONTLINE,

I thought the show was more balanced than most on HMOs and managed care in general. However I thought that more emphais on the "good old days" and the excessive healtcare provided then would have been helpful. Also the show seemed to focus on just HMOs, and mainly for- profit ones . There was little discussion in general of non-profits. There was also little discussion of how the nursing profession has advanced in a positive way -- many do more and are more actively involved in the delivery of health care more than ever before and are compensated a higher levels than ever before. I thought it would have been beneficial to focus on more than one HMO CEO for balance. Thanks for listening.

Washington, D.C.

Dear FRONTLINE,

Malik Hasan is on the right track to repair the healthcare industry that has failed us in the past.

If the doctors in the past were not over-charging the insurance companies, it would still be feasible for companies to provide these types of plans for employees. HMO's have created a cheaper alternative because they MANAGE the care that the doctors should be providing.

As for the nurses, I truly feel sorry for their situation because they are proof of the greed from the hospitals and doctors who are still making a bundle due to the cutbacks being placed on the nursing staff.

We still have a long way to go. Any type of improvements are better than none.

C Wells
cwmo@sprintmail.com
NYC, NY

Dear FRONTLINE,

Nearly three years ago, my sister began suffering from a mysterious ailment which seemed to involve liver function. Her HMO physician could not determine the cause and sent her to various HMO-approved specialists. Each referral appointment was at least one week after the referral. By the time she was biopsied two months after her original complaint, she had virtually no liver function. The HMO physician pressed for evaluation at a University medical center where it was determined (1) she was in desperate need of a transplant and (2) she had autoimmune hepatitis. Less than one month after this determination she was near death, suffering hepatic encephalopathy and various other liver related complications. While in the hospital awaiting transplant, her HMO cancelled her coverage on Friday at 5:30. Her husband was then forced to mortgage his business so the plans for surgery might continue. She received a transplant the following week. Her husband was told she would probably have not lasted much longer.

The problems I see in this situation lie squarely in the HMO process. The well-intentioned physicians she first saw were forced to follow a line of procedure which they might have skirted had it been allowed by the HMO. There MAY have been time to treat her autoimmune hepatitis before it destroyed her liver. Had the HMO behaved honorably, the family would have been spared gut-wrenching desperation.

I very deeply and personally resent the intrusion of big business politics in health care. It is very obvious that medical professionals feel their hands are tied. The public needs to be made aware of this crisis in health care. This episode is only part of what needs to be done.

As a post script, my sister is now doing well. Her lawyer was able to get the HMO to pay for at least some of her medical costs.

Mooresville, NC

Dear FRONTLINE,

As always, there are at least two sides to every story. In tonight's PBS showing of FRONTLINE, however, there seemed to be at least TEN sides to the story of the changing atmosphere of today's healthcare. From the direction of consumers (formerly known as Patients); to providers (formerly known as Doctors/Physicians); and to observers (formerly known as Families and Friends).

I am a physician, a mother, a patient, and a registered nurse. I first entered the healthcare field in 1968. I have worked in facilities from N.Y. to Mexico, with brief periods of time in Dominican Republic, Italy, Greece, and back again, giving me a wonderful experience and exposure to different types of healthcare systems. I have definately seen a lot of change over the past thirty years, most of it good.

I am witness to a much different atmosphere now. One where each "side of the story" seems to have lost respect and trust for the others. In my opinion, there is more anger, frustation, disappointment, disillusion, rudeness, apathy, loss of caring, than EVER seen in the entire history of Medicine. Patients are rude to doctors and nurses. Doctors are uncaring to patients and nurses. Nurses are apathetic to patients and disrespectful to doctors. And so on. So in tonight's movie, my heart went out to every single participant in one way or another. I could relate; identify; sympathezize and understand many facets of the multi-sided story.

I don't know what direction all this change will take. I do know that I feel scared and afraid of what lies ahead, and for me anyway, providing healthcare will never again have the reward and satisfaction of truly trusting, reciprocating relationships that I have known during these past thirty years.

Where is it going.....? Who will win; who will lose......? Is it time for me to say "goodbye" and turn down a different road in a new direction...........? Maybe.........................

Debra A Ough
debough@aol.co,
Chittenango, NY

Dear FRONTLINE,

One underappreciated consequence in the stampede to managed care is the destruction of the infrastructure of medicine. Previously Doctors (particularly surgeons) would work for well into their 60's and would retire only after bringing in an associate to train. Now surgeons are retiring or transitioning to other careers before reaching their peak, and without training associates and honing their skills. The result is an increasing death of less adequately trained physicians who must relearn these lost lessons gleaned from experience largely by trial and error on their patients. Heaven help us when we or our loved one's are stricken ill.

Randy Black, MD
reblack@concentric.net
Albuquerque, NM

Dear FRONTLINE,

Thank you for a most informative program. I am a nurse for the past 40 years and am presently responsibile to maintain Quality Standards of care in a 474 bed facility. Managed care will bankrupt the health care system if it continues unbridled. I was appaled at the lavishness of Dr. Hassans office. No one mentioned the salary he makes and where it comes from. I was paticularly touched by the nurse's dispare at not being able to utilize her training, experience and compasion in caring for patients. I can relate to the resistance to change when change is not for the better. Managed care has succeeded in rationing health care more efficiently than any Socialistic Country. It's very diheartening.

Carmela M. Fallon, RN
RNqa@aol.com
Baldwin, Long Island, New York

Dear FRONTLINE,

I think that Hasan and his big HMO is destroying the integrity in America. He cares about nothing but making money. He does not care about the health of the patients who are members of his HMO.

I have had first hand experience with this at Health Parners HMO here in the Twin Cities in Minnesota. Health Partners is probably one of Hasan's evil organizations (although not verified). The man cannot even use correct grammar in speaking much less run the biggest HMO in America.

Health Partners here in the Twin Cites is commonly referred to as "Death Partners" by its patients. It is nothing but bullshit. If I may explain, I almost died of an alergic reaction to Sulfa drugs, and they made me make an appointment for urgent care then wait there for 2 and a half hours before anyone saw me. Had I died, they would have been responsible, and then probably would have made some kind of excuse.

Health care in America is getting nothing but worse and worse and worse. These huge privatized HMO's care nothing about their patients, just about saving money and efficiency. Hasan can take this "efficiency" and shove it right up his big fat business ass. There, now I have given you a piece of my mind about this, and feel only a little better. You can show that bastard (Hasan) this letter, I really don't care.

This show (Frontline) has really made me think. I think that it was good how this show exposed the health care system, and how bad it really is. It's a good show, keep up the good work PBS.

Dear FRONTLINE,

Enjoyed your program. I'm responsible for reimbursement at our local hospital and I see first hand the problems caused by forced reductions in staff and resources due to decreased reimbursement. You have only revealed the tip of the iceberg in the difficulties hospitals and physicians are faced with in trying to provide high quality care in the face of Managed Care and government bureaucracy. Our hospital has also tried having broader job descriptions for housekeepers, aides and clerical staff in order to free up some time for the RN's. We are finding we cannot retain staff for these positions, so we are spending more money in continued employee training. Give the nursing jobs back to the trained nurses, and give health care decisions back to the trained physicians. What are people going to do when the government's and MCO's ridiculous regulations force THEIR hospital to close? This story needs much more attention!

Ron Kelley
rkelley@cambridgeoh.com
Cambridge, OH

Dear FRONTLINE,

Fantastic. Please bring us more programs on the subject. I deeply resent the dehumanization of medicine in America. MBAs should not decide what therapies are given to whom.

Derby Line, VT

Dear FRONTLINE,

I think that we now have a lot of non-health care professionals telling healthcare professionals what they can and cannot do. There are too many cases where by the time the HMO approves the referral to a doctor outside the approved list of providers, the patient is more seriously ill and usually requires more extensive and expensive care then if they had originally been allowed to go the specialist.

As a pharmacist, I feel that too many patients are not being allowed access to medications that may cost more but requires less doses per day. The fewer doses per day a patient has to take a medication usually translates to better compliance. But, many are denied the newer dosage forms due to their increased cost per tablet or capsule.

Margaret H. Devine
mrgret@aol.com
Hempstead, Texas

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