The Coastal Post - February, 1996

Damaged Care: Insurance Companies And Politicians Are Dismantling Medicial Care

BY EDWARD W. MILLER

The public remains confused by the on-going debate over government's role in medical care. The confusion is fostered by the insurance industry which, determined to hold onto its expensive share can only do so by misrepresenting itself. By massive lobbying the industry keeps its hand in the till where it extracts at least a third of the medical dollar while providing misinformation, reduced treatment options and added expense to the public.

The insurance conglomerates are doing their best to outwit the voters. With millions of lobbying dollars injected at both state and federal levels, they have purchased our representatives to help them steal from the taxpayer. That array of HMOS and other market-driven health organizations already functioning represent the intrusion of big business between the taxpayer who needs but must pay for his care, and the suppliers of that care.

Under "single-payer" plans, which Canadians and most Europeans enjoy, government foots the bill. The suppliers: physicians, hospitals, clinics, pharmacists, radiologists and other specialists, nursing homes, etc., bill government directly for their services. Since government guarantees these services,there is nothing to "insure." With government paying the provider directly that terribly expensive middle man, the insurance industry, is kept out of the picture. With single-payer plans, physicians have a variety of choices: they may practice by themselves or in clinic or hospital groups. Hospitals also can stand alone or join other hospitals and clinics to combine resources and services in various ways. Medicare, basically, is "single-payer," a form of socialized medicine.

Unfortunately, much of organized medicine in the U.S. has made a Faustian bargain with the insurance industry. The AMA, already bought by those giants, launched a massive e-mailing (300,000) to its members discrediting the Canadian system as "socialized medicine," and joining the insurance companies, hired a public relations firm, Burston-Marstellar, to sell "managed care" in the U.S., while discrediting Canada's health plan both here and in Canada. (BM earned $82.1 million in lobbying fees in 1992-93.) The firm, with offices in Canadian cities, has been feeding misinformation into the local press undermining Canadians' trust in their own system.

No physician likes restrictions so neither his fees or choice of treatment, but with the "managed care" being pushed in Washington, doctors are finding themselves doubly restricted, both by their HMO or other insurance-formed organization, which in turn will be restricted by government. Manager care actually represents "minimal care," i.e., the only level of care possible after the insurance industry has taken its bite from the medical dollar. The patient meanwhile, computer-herded into some select group on the basis of income, race, sex, age or medical history is beginning to realize that the special relationship with his physician has been taken away. Both provider and patient will pay the price.

There are presently over 40 million in the U.S. without access to adequate health care, Americans must learn to guard every medical dollar. The politicians' present scare campaign regarding the upcoming bankruptcy of Medicare is based on a fraudulent misrepresentation. The Nation's editor (October 16) had these comments: "Since its inception in 1965 on nine different occasions Medicare's Hospital Trust Fund, financed by payroll taxes, has been said to be seven years or less from hitting the wall. Each time, Congress has responded with various fixes...Washington could easily muddle through the present Medicare mess with $89 billion in modest shifts and cuts over the next seven years as the Fund's trustees have suggested... The current drive in Congress isn't really about stabilizing Medicare or its companion Medicaid. It's about raiding these two entitlement programs to pay for a $245 billion tax cut for the rich... The federal guarantee of health care for the poor and disabled...is about to be block-granted out of existence."

Only a single-payer system, supported by both taxpayer and business can support basic care for everyone. Those who can afford additional coverage will always find insurance companies eager to assist. The health of this country depends on everyone having access to his physicians. The insurance lobby intends to create division amongst Americans, pick the pockets of the rich and upper middle class, and even milk a few extra dollars from those dependent on Social Security by offering stripped-down "managed care" options.

Already, evidences of the larceny resulting from collusion between the AMA and the Republican majority is beginning to appear in the news. The British Economist (September 23, 1995) noted: "Groups of doctors at three Long Island hospitals filed a lawsuit in federal court...accusing Aetna Life and Casualty Company of violating anti-trust law by putting pressure on the doctors to sign contracts that would make them part of Aetna's health care plan." The suit said Aetna threatened to cut hospitals from its plan if the physicians did not sign. Amongst the doctors' many complaints was that their contracts allowed Aetna to alter the terms unilaterally, and that physicians could be dismissed without cause.

Fred Gardner, writing for the Anderson Valley Advertiser (June 11) reported that, "Eli Lilly purchased McKesson's drug distribution unit, PCS Health Systems, for $4 billion...and that Lilly's CEO Randall L. Tobias in a speech to Boston business executives as reported in the Wall Street Journal had detailed how his company "was using PCS data on 56 million patients to maximize use of Lilly products." Tobias noted: "Computerized reviews...can help identify people who are being treated with what appear to be unrelated ailments, such as backache and sleeplessness that often are in fact symptoms of depression." He added: "As a result we can develop depression management programs that often include Prozac US (a Lilly product)." Gardner also noted: "The National Association of Chain Drugs, a group representing 30,000 pharmacists those members include Thrifty, Payless and Longs, had formally advised the Federal Trade Commission that the purchase of PCS by Lilly put the consumer at risk."

According to Martin Gottlieb, writing in The New York Times (October 31): "Medicare and Medicaid measures working their way through Congress would allow physicians to engage in business enterprises now forbidden. The AMA is pushing this. The House version, according to Gottlieb, "would allow doctors to start physician-run health groups to compete with HMOs, allow physicians to set prices in way that now violate anti-trust laws and switch from state regulations to federal policing of physicians. The Senate version would permit higher physician fees for Medicare patients.

The House Republican plan also relaxes restrictions on physicians operating labs, owning companies and referring patients to their own facilities... It "heightens" the government's burden of proof in fraud restrictions on physicians' plans would be loosened, would be state-controlled, thus setting the stage for bankruptcy. Medical societies and physicians could write their own standards. "Such laws in the past have been used to squelch competition," Gottlieb notes.

On December 20, Robert Pear, writing in The New York Times, reported that physicians country-wide were complaining about the limitations being placed upon them by HMOs. "Ill feeling over the restriction is growing," Pear said. Doctor Christine K. Cassell, president of the 30,000 American College of Physicians, said: "To my dismay, gag orders are becoming more common." Pear reported a notice to doctors working for Kaiser Permanente HMO in Ohio warns: "Do not discuss proposed treatment with Kaiser Permanente members prior to receiving authorization from an outside company that sets guidelines for the treatment of patients." He noted: "Some doctors want to recommend treatments not covered by the HMO in which the patient is enrolled. Their ability to do so may be severely limited by a confidentiality clause."

Doctor Himmelstein, prominent Boston physician and associate professor of medicine at Harvard recently co-authored an editorial in the widely-read New England Journal of Medicine which stated that: "Some HMOs use financial rewards and penalties to force doctors to skimp on care and then try to prevent them from speaking out. Doctor Himmelstein was shortly thereafter terminated "without cause" by the HMO for which he was working. (New York Times, December 20.)

Many elderly in this country who recall the failures, inadequacies and outright absence of health care service run by the states before Medicare and Medicaid were instituted are understandably fearful that the Gingrich "block-grant" threaten to dump federal health services back onto the states will return us to those days of haphazard and marginal care. Fact is recent actions in Republican lead state legislatures, as described by Barry Yeoman in The Nation (December 23) are a warning of such things to come: "Washington's Republicans...gutted a 1993 health care reform law...which could leave 300,000-400,000 people without health coverage" in that state. In Montana, the "Federal Mandates Act passed last April proclaims the state has the authority to disobey any federal mandate that does not conform to Montana's customs and culture," and in North Carolina the legislature cut the funding for abortions for the poor from $1.2 million to $50,000.

Whatever final versions of Medicare and Medicaid survive the on-going jousting in Congress, will in the years ahead touch every American family.

The motto clearly visible to all those entering the old Roman market read: Caveat emptor, or "let the buyer beware." Has anything really changed?