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Mt. Holz Science Fiction Society
Club Notice - 12/03/99 -- Vol. 18, No. 23
Chair/Librarian: Mark Leeper, 732-817-5619, mleeper@lucent.com
Factotum: Evelyn Leeper, 732-332-6218, eleeper@lucent.com
Distinguished Heinlein Apologist: Rob Mitchell, robmitchell@lucent.com
HO Chair Emeritus: John Jetzt, jetzt@lucent.com
HO Librarian Emeritus: Nick Sauer, njs@lucent.com
Back issues at http://www.geocities.com/Athens/4824
All material copyright by author unless otherwise noted.
The Science Fiction Association of Bergen County meets on the
second Saturday of every month in Upper Saddle River; call
201-447-3652 for details. The Denver Area Science Fiction
Association meets 7:30 PM on the third Saturday of every month at
Southwest State Bank, 1380 S. Federal Blvd.
===================================================================
1. Last week I said why I think that the Health Maintenance
Organizations (or HMOs) were not just facing conflicts of interest,
they really were in the conflict of interest business. Essentially
they are able to turn a profit by the denying what is the best but
also the most expensive health care.
I suppose originally HMOs saw the huge increase in medical
spending, paid for in large part by corporate benefits packages,
and they said they could help corporations manage the cost.
Perhaps at one point it seemed like a good idea. But the HMOs
threw themselves right in the middle of a situation where life and
death decisions were being made and said that they could be trusted
to make those decisions. For a money-making corporation to go into
the life and death decision business sounds on the face of it to be
foolhardy. And it really is. And it is particularly true in this
litigious society. They would have to have a private army of
lawyers to fight off the litigation and the inevitable bad
publicity that they would be getting. Doctors make the same sort
of decisions, but it is easier to trust a single person. It is
difficult to trust the anonymity of a corporation and to know the
corporation innately has to please its stockholders and to make a
profit by saving on healthcare costs. The astronauts used to joke
about how insecure they felt sitting on top of a rocket made of
some huge number of parts, each provided by the lowest bidder.
Anyone who gets his healthcare from an HMO knows how the astronaut
felt.
The HMOs currently have immunity from patient and survivor
lawsuits. Perhaps they should since juries are tending to give
large awards when individuals sue large corporations. Juries also
know the lawyers will take a large cut of the proceeds and they
want some to be left over for the injured parties. Right now the
laws mostly stand in the way of individuals suing their HMOs and
the HMOs are generally protected by a somewhat sympathetic
Congress. That cannot last. When the public starts to see their
elected officials siding with the corporations against them,
suddenly Congress will have a change of heart and suddenly being in
the healthcare control business will become very much less
profitable.
In the end I think people will realize that the HMOs are not an
effective tool against higher medical costs. Sooner or later for
the HMOs to avoid being stung to death by lawsuits they will
probably be forced to make much the same set of decisions that
personal doctors would have made and perhaps they will have to be
even more liberal than private doctors would have been. Every
decision they make that is more conservative than a private doctor
would have made opens them up to the possibility of litigation.
The cost of medicine will return to what it would have been without
the HMOs PLUS the cost of more liberality to cover themselves PLUS
the cost of the operating expenses of the HMO. The corporations
will see that going with the HMOs was short-sighted. It was a
short-term savings that will cost more in the long run. When that
happens the same corporations that flocked to HMOs to save money
will probably decide that health care is just too expensive a
benefit. They will stop offering it altogether and perhaps the
better companies will sweeten salaries a little, but not nearly
enough to cover health care costs. Then we will find a lot of
people just not able to get health care. Rather than forestalling
that day the HMOs have hastened it. [-mrl]
Mark Leeper
HO 1K-644 732-817-5619
mleeper@lucent.com
The average dog is a nicer person than the average person.
-- Andrew A. Rooney