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    Health Care Reform:

    Health Insurance & Affordable Care Act

    A doctor speaks out.

    The HMO Fiasco

    Free Care for the Rich?

    Doctors traditionally have been expected to provide free care for the poor. It is only now in the age of the HMO that they also have to provide free care to the rich, who assume, quite reasonably, that their doctors are well paid. It's true, the HMO insurance premiums aren't cheap. Someone is getting the money, but it's not going to the people who actually provide the care.

    A friend, a sophisticated attorney with an income well into six figures, asked me to help him get into the practice of a very fine local internist who is not accepting any new patients. I asked my friend what insurance he had, and when he named a local HMO, I told him I could not help him. "Why?" he asked, "We paid a lot of money for this policy." I explained that my friend was already overwhelmed with HMO patients.

    I suggested a deal. "Why don't you agree to provide all of the doctor's legal needs for a year for $200 if he will accept you as a patient?" "Why would I want to make a deal like that?" he asked, "I'm not an insurance company!" "Well, neither is he," I said.

    "I can't believe it's really as bad as you say it is. Why did you guys sign such a contract? Why don't you just raise your fees?"

    Why indeed? Those are very good questions. The fact is, we were never given an opportunity to negotiate. It was "take it or leave it." We signed such contracts so we could continue to receive referrals from the primary physicians in our community. We also thought that because the contracts applied to a minority of our patients, we could make up for the losses with other patients covered by conventional fee-for-service insurance plans. That worked until those other patients were forced by economic pressures to also join HMO plans.

    So, are doctors in my community starving? Of course not, but many have left their practices. Even those medical offices with the most highly trained and qualified senior physicians are having difficulty recruiting new physicians to assist with their workload, because they cannot offer enough salary or benefits.

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