Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, June 13, 1994 TAG: 9406270127
SECTION: EDITORIAL PAGE: A-4 EDITION: METRO
SOURCE: By CARROLL SMITH
DATELINE: LENGTH: Medium
A mother is told that her mentally disturbed daughter cannot go to the psychiatric hospital recommended by her doctor. She has to go to a cheaper place without specialized care.
A patient is told that she cannot have the drug prescribed by her doctor. She must use a cheaper one or pay for prescribed drug herself.
A man is refused for a referral to an orthopedic specialist. Later he's diagnosed as having a ruptured spinal disc.
A young doctor, on her first job out of medical school, is warned that she's spending too much time with her patients and seeing them too often.
I could add to these examples. But the important point is that these decisions weren't made by Thomas' dreaded ``government bureaucrats, '' but by employees of insurance company-owned managed-care facilities.
Thomas attributes the problems he reports to ``a shortage of cash.'' The insurance companies, in my examples, have no such problem. In fact, insurance company HMOs have had rapidly increasing profits in the recent past, their stock prices are climbing, and many can pay their CEOs multimillion-dollar salaries. There's a difference in saying to a hypothetical patient, ``We must delay or limit your treatment because we do not have the money or staff to do it,'' or ``we must do it because we have to consider our bottom line.'' Of course, this isn't really what insurance companies will say. However, they are businesses, and profit is the difference between income and expenses. To maximize profit, they must minimize care.
A quick look at the demographic data in the Encyclopedia Britannica shows that Canada has better figures on longevity (both men and women), infant mortality and total mortality. This is done with 15 percent fewer doctors on a per capita basis than in the United States. A related point is that HMOs typically require their doctors to handle two or three times the patient load that's common in the usual private practice. What are we going to do with all these unemployed physicians?
Thomas' most astounding statements are in the following paragraph. I've substituted some of his words. His original words are in parenthesis. If it's read both ways, which seems the most plausible?
``This is a preview of what Americans can expect if we turn over the management of our health to insurance companies (the government), which will place cost, rather than our lives, as its top priority. Since my health and life will always be of greater value to me than to an insurance executive (a government bureaucrat), guess who is likely to prevail if a dispute arises about medical treatment?''
Clearly, a single-payer system would be the best for everyone except insurance companies and profit-making hospitals. Most Americans prefer it when it's explained to them. We aren't likely to get it because the insurers and hospitals have millions to pour into propaganda campaigns and public-interest groups have little wherewithal to provide an answer.
Carroll Smith of Shawsville is a psychologist.
by CNB