Let's get the profit motive out of health care
Dr.George L. Pauk
Most physicians, such as myself, who have practiced
medicine for several decades have witnessed with regret the radical changes
brought about by the takeover of health care by large insurance companies
and HMOs.
In Arizona, the impact is severe. Patients
costs are rising, they have much less choice of their doctors, and the
number of people with no insurance or poor insurance is soaring.
Most important, recent studies show that quality of health care is comparatively
poor in the investor-ownership plans.
HMOs have become powerful commercial and political
machines. Politicians have guaranteed solvency and large annual profits
to this well-heeled industry. The main thrust of HMOs is to enroll
the healthy, avoid insuring people with "pre-existing conditions," get
rid of high-risk individuals, and delay the delivery of care and payments
to maximize profits. The inclusion of all citizens in high quality
care is anathema to the health insurance industry and it has lobbied vigorously
and at high expense against the concept. Its mission is profits for
shareholders.
Comparison of many, overly complicated schemes
of insurance coverage is difficult, but a major of studies indicate that
HMO care is inferior to fee-for-service care. This is true particularly
for the elderly, the chronically or seriously ill, and the poor.
A new study also finds that for-profit, investor-owned HMOs are worse in
quality than not-for-profit HMOs. The for-profit plans spend 50 percent
more on overhead and profits.
The study, reported in the "Journal of the
American Medical Association," found that investor-owned HMOs scored worse
than non-profit HMOs on every one of 14 quality measures reported to theNational
Committee for Quality Assurance. Some of the biggest quality differences
were in the care of the seriously ill patients--- patients with diabetes,
heart disease, or mental illness. Investor-owned plans had a 27 percent
lower rate of eye exams in diabetics; a 16 percent lower rate of appropriate
drug treatment for heart attack survivors (use of beta-blocker medicine);
and a 9 percent lower rate of follow-up for patients is charged after a
psychiatric hospitalization.
But, the for-profit plans were also poor at
preventive measures. Childhood immunizations were 12 percent lower, women's
Pap smears were 9 percent lower, and mammography rates were 8 percent lower.
The profit motive also worsens hospital care.
For-profit hospitals are more expensive than not-for-profit facilities,
and a report in the Aug.5 "New England Journal of Medicine" shows they
cost Medicare an extra $5.2 billion in 1995 alone.
Other studies show that for-profit-hospitals,
like their cousins in the HMO industry, spend more on overhead and administration.
They also hire fewer nurses, provide less charity care, and provide patients
with fewer hospital days than not-for-profit facilities.
Our nation's experiment with marketplace medicine
is a dismal failure. Despite spending twice as much on health care
(per person)as any other country in the world, there are now 45 million
people without any insurance, and this number is rising by 125,000 people
every month. Arizona and the nation must move to a simpler, more
fair, and higher quality system --- a not-for-profit national health program
that covers everyone using the principles of democracy. The health
of the public is as critical as a social responsibility as fire or police
protection. It's time that our society join the ranks of the other industrial
countries --- Denmark, Sweden, Japan, Australia, Canada, etc. --- and consider
health care a right.
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Dr. George L Pauk is a Phoenix physician specializing in internal
medicine and endocrinology. He is an investigator for the Diabetes
Prevention Program and a staff member of the Phoenix Indian Medical Center.