Don't Fear the Reaper

by Luke O'hara

But here's why you should develop a healthy fear of the state of health care in this country. HMOs (Health Management Organizations), the oft talked-about, more often villainized overlords of sick and doctor alike, are at the crux of the Tower of Babel that is American health care. First and foremost, HMOs are corporations (for those of you who thought maybe they were fucking everybody just for the fun of it), and that means one thing: MONEY. That's right, even the HMOs don't just play for the love of the game.

HMOs rode in on their proverbial white horse in that innocent time we all remember, the early 90s. They were the insurance companies' answer to calls to nationalize health care, a response that basically read, "No, wait, we've got something much more complicated."

HMOs are a corporate function of the role that the government plays in countries with socialized medicine. People pay into HMOs and in turn receive list of doctors and conditions of coverage. When a person goes to see a doctor on this list, the HMO will pay the doctor for this visit. The doctor, however, must first file for payment - a long and time-consuming process - in turn receiving less than his or her fee was to begin with. Consequently, some disgruntled doctors often perform half-hearted exams, using the bare minimum of time and effort to receive their substandard payment.

Feeling pressure from all sides, the government is hot to reform HMOs. Patients complain of limited and often incompetent care and coverage. Most HMO's have "practice guidelines" (or, to HMO critics, "cookbook medicine"), which is essentially the "Thou shalt not" list of medical coverage. These are the guidelines that cause the strife of the unfortunate and infirm - which the media loves to fill its Features sections with. Doctors complain of mountains of red tape involved in obtaining withheld fees; however, with the "Patients’ Bill of Rights" floundering and watered down, it seems the fervor is just more election-year pillow talk.

HMOs want to delay paying their doctors because they want the money for as long as possible, since the longer they have it, the more they make. Yet the recent rise in HMOs going out of business seems to suggest that even the capricious Olympian bureaucrats are doing little more than keeping their heads above water on the deal.

Doctors’ calls for change mainly take the form of demands for a return to a "Fee for Service" system of health care. While it’s certainly a streamlined and simple system, the fact remains that this system is one for the rich. Although quality of care would be improved, cost would increase for many of the people most unable to pay.

On the other end of the spectrum is the potential of nationalizing health care. Coverage would be universal, and cost would probably be more manageable for people below the poverty line. As in other countries with socialized medicine, some people would probably go outside the system to pay "Fee for Service," thus receiving preferential treatment and condemning the national system to a similar mediocrity as what we have now.

So what's going to be done about this? Well, probably nothing. The question under consideration is, "How does one make it profitable to give medical care to poor people?" Or, in other terms, how does one remove the corrupting influence of money without creating the inefficiency and mediocrity that seem to be present in more egalitarian solutions? Well, one doesn't, at least not in America, where radical solutions earn one a date with Larry King and not much else.