Few pieces of legislation have ever been attacked as viciously as President Clinton's health care plan. When the neophyte Clintons floated their well-intentioned but unwieldy plan to nationalize health care in 1993, it was strafed from all sides. Burdened by its own weight, the plan proved an easy target, quickly buckling under the attack and then exploding like the Hindenburg. What had started as a lesson about the inequities of health care in America ended as a demonstration of the awesome destructive power of special interest groups.
Leading the attack was the health insurance industry, which stood to lose the most. Its arguments seemed valid: A national health care plan would quickly develop into a huge, impersonal system. Patient care would suffer at the behest of government administrative incompetence. Too much of America's health care dollar would be spent on bureaucratic overhead. A point that resonated especially well with voters: Patients would lose the right to choose their own doctors.
Americans, influenced by slickly sincere "Harry and Louise" ads extolling such fears, were quickly spooked and the flaming wreck of nationalized health care crumpled to the ground as liberals cried, "Oh, the humanity!"
Cut to present day - the smoke has cleared to reveal a surprising scene. Patients have lost the right to choose their own doctors. A huge chunk of America's health care dollar supports administrative overhead. Patient care has suffered. Is this Clinton's health care plan resurrected? No, it's the health maintenance organization revolution. After pelting the public with dire warnings about a Clinton health care plan worst-case scenario, the insurance industry has brought us a startling realization of that very scenario. The key difference, of course, is that the insurance industry is now calling the shots. And reaping the gain.
The ostensible advantage to HMOs, in which insurance companies set health care guidelines in the interest of controlling costs, is a more efficient health care system. The disadvantages? Have a seat.
Doctors who agree to join HMOs answer to rigid HMO bureaucrats obsessed with cutting costs - at any cost. These doctors are also often subjected to "gag clauses" that forbid them from suggesting costly or unproven treatments to patients, regardless of the circumstances or benefits. As a result, doctors are forced to abandon their role as trusted patient advocates.
HMOs often pay health care providers a flat fee to provide care, regardless of the number of patients the provider tends to during the term of that agreement. The result? A powerful incentive to bring assembly-line care to the most personal of levels. The more patients a doctor can usher in, then out the doors, the more money he or she stands to make. Not surprisingly, patients forced to abandon a trusted family physician to join one sanctioned by their company's new HMO are less than thrilled to discover their new status as "annoyance." HMOs also control many other aspects of the health care process, right down to the labs. In Milwaukee, one slipshod HMO lab, which had cut corners to the point of incompetence, misread pap smears and biopsies from patient Karin Smith as "normal" not once, but six consecutive times. Smith only discovered she had advanced cervical cancer (eminently treatable in its early stages) after ditching the HMO system altogether to consult an independent physician. The result of such HMO "efficiency"? Smith, 29, died of cervical cancer.
It gets worse. The HMO's typical stance on mental health treatment? Deal with it. The HMO's typical reaction to a member's fatal disease after even the slightest hint of a pre-existing condition? Eat the bill and die. The HMO's typical rule on emergency room visits? Call us first to beg permission. Never mind if you're too busy bleeding to pick up a phone - in New York State, one HMO, U.S. Healthcare, earned infamy for refusing to cover costs for pregnant women because they failed to "precertify" while en route to the hospital via ambulance.
The cost-cutting mantra of HMOs has proved to be unbending, cold and downright ruthless. HMO executives claim that the line must be drawn somewhere; health care, after all, is not an inexhaustible resource and at some point expenses need to be checked. Their reasoning would seem to have validity - were it not for the shocking amounts of money these very executives have quietly siphoned from your health care dollars.
Example: Pueblo, Colorado's, Malik Hasan, CEO of managed-care powerhouse QualMed, became worth $150 million upon taking his company public. Example: When Hasan purchased California HMO Health Net in 1993, he smoothed the way by waving $3.2 million under the nose of Health Net's own well-to-do CEO Roger Greaves - who later left the company with a severance package worth $18.1 million tucked under his arm. Example: A proposed merger between Aetna Life & Casualty Co. and U.S. Healthcare stands to enrich U.S. Healthcare founder Leonard Abramson by - this is not a typo -- $920 million.
The costs of government overhead, so widely decried during the 1993 health care debate, pale in comparison to the drain of such corporate profit-taking. While Medicare spends 2 cents of every dollar on administrative overhead, U.S. Healthcare spends a whopping 15 cents. Add the 10 cents the company packs away for profit and a quarter of every dollar is diverted away from actual health care. Considering that U.S. Healthcare pulled down $3.6 billion in revenues last year, arguments that it cannot afford to foot emergency room visits for pregnant women seem, at the very least, disingenuous.
Such is the "efficiency" of our new health care system: Savings realized from denying treatment to the sick and dying are used to subsidize the lavish lifestyles of those who have hijacked the system for financial gain. This kind of transaction between profiteer and victim has a long history in our society -- it's called murder for hire. Sound outlandish? A Milwaukee prosecutor brought Karin Smith's killer, the lab that egregiously flubbed her cancer tests, before a jury of charges of reckless homicide -- and won.
Transforming the U.S. health care system into a personal profit playground for the industry's shameless elite didn't happen overnight. Such a gargantuan task takes years of time, preceded by years of planning. That planning was indubitably in the works when President Clinton stumbled into the way, threatening to usurp the entire scam with his reckless talk of universal health care. In 1993, Clinton dared to articulate a belief that the world's lone superpower should be capable of providing for the health of its citizens. Only now, is it clear why his plan was destroyed with such brutal efficiency. America's health insurance industry, it turned out, had plans. Big plans.
© 2002 by firstname.lastname@example.org
Originally published in the Boulder Weekly, July 18, 1996.