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Health-Care Reform

October 09, 1994

As a participant in one of California's and the nation's leading HMOs, I believe that David Ewing Duncan's article, "The Triumph of Harry and Louise" (Sept. 11) was misleading. HMOs represent the kind of reform that everyone seems to want: access to a wide choice of primary-care and specialty physicians and hospitals; additional benefits; lower overall costs, and a dedication by the plan and its physicians to emphasize health and well-being, not just illness--all while reducing the paperwork found in traditional Medicare and group insurance.

Unlike those in some of Duncan's scenarios, most HMO members can vote with their feet--discontinue their membership at a moment's notice--but most choose to stay in the plans. In the case of our own "Secure Horizons," the retention rate is 95%. In our Health Insurance Purchasing Cooperative for small businesses, more than 80% of the 44,000 members have chosen HMOs.

Doctors and hospitals have not been as powerless in all this as Duncan suggests. Physician groups in California are showing how doctors can reorganize their practices to become more efficient and effective.

California is setting the tone for reform. While other options should be available, it is in everyone's interest that the HMO--the only proven solution to the health-care crisis--be retained as a choice.

Dr. Roger S. Taylor

Executive Vice President

PacifiCare Health Services

Cypress

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Duncan replies: Dr. Taylor describes the HMO ideal, to cut costs and increase efficiency, but fails to mention that many HMOs achieve savings, and earn hefty profits, by skimming off the healthy and excluding the sick, and by dropping those who become ill. Despite his claims that HMOs offer a wide range of choice, the truth is that most are in the business of reducing costs by restricting provider options. And it should come as no surprise that most enrollees are satisfied with their HMOs since most are healthy and use their plans only for routine care.

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Managed care is the area of medicine where medical professionals oversee patient care to ensure the most cost-effective use of medical resources consistent with quality patient care. Many health-care providers, such as small medical groups, are owned by the physicians who practice in them. They tend to police themselves, since malpractice suits against one eat up the profit for all.

The system needs to be fixed, but establishing a federal or state medical bureaucracy isn't the solution.

Pete Lister

Castaic

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I own a small business that provides full medical insurance to my 15 employees and their families. When costs recently forced me to switch to an HMO plan. I was assured that our current doctors and hospitals would be available.

It took me three months to see my primary-care physician for a referral to a specialist I'd been seeing for 10 years. The referred visit was twice denied by an insurance reviewer, even though the specialist was a participant in the plan. It took some heavy telephone shouting before the insurance manager issued permission for the visit.

I'm now concerned about the value of our medical coverage in case I or any of my employees need serious and expensive medical attention. This is one business owner who is definitely in favor of a single-payer, state-supervised medical insurance plan.

J. M. Steininger

Santa Barbara

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Doctors are no more or less avaricious than anyone else. It's just that they have more opportunity to act upon greed. Their exalted image and the ever-present threat of malpractice suits make it easy for them to rationalize excessive treatments and billings. Physicians rightly resent that some lay persons in the insurance industry question their decisions, but the doctors' abuses of unrestricted freedom made such review inevitable.

Much of the criticism directed against HMOs is justified; there are legitimate complaints. But the HMO industry would not exist if fee-for-service medicine hadn't gotten out of hand.

Harry Mass

Tarzana

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Maybe I should hire a director and an editor, buy some TV time, be filmed sitting at a kitchen table with a sympathetic friend and tell how not having health care resulted in the death of my father. How because he was too young for Medicare and made too much money for Medi-Cal, he couldn't get the angioplasty he needed and died of a heart attack at 59.

Perhaps I could sob a little as I tell how, 11 days after my father's death, the Veterans Administration sent a letter telling him in essence that, yes, he was sick enough; he could have an angioplasty.

We need affordable health care.

Julie T. Byers

Temple City

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Government involvement will eventually cost us all more in tax dollars, and provide us with less medical care than we now get. We must leave health care and its controls in the hands of

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