The HMO Fiasco
Efficiency Rewarded, Quality Punished
The failure and bankruptcy of medical groups and offices driven to failure by HMO contracts is becoming everyday news. Unlike other businesses, unfortunately, these failures do not involve just the marginal enterprises but frequently the most esteemed practices in the community. The reason is obvious. "Efficiency" is rewarded, while quality, compassionate medicine ends up being punished.
Like many of my colleagues, I did not go into medicine for the money. Yet now I find the payment system and its perverse incentives are driving me away. If I could be convinced that the present dysfunctional system, as bad as it is, were the only way to achieve "universal health care," I would consider it a worthwhile sacrifice. Unfortunately, the exact opposite is occurring: While more patients are driven into HMOs, many others find themselves without any health coverage whatsoever.
I accept that the HMO concept was a possible solution to the skyrocketing cost of health care. Kaiser-Permanente, a not-for-profit institution, was a good model. It was a big mistake, however, to assume that market-driven, investor-owned, for-profit HMOs could be trusted to provide a fair balance between profits for the stockholders and health care for the public.
Although I personally feel that a single-payer national health plan should be our goal, in the short term we need to take our health care out of the hands of profit-driven corporations and put HMOs under public oversight. Essential utilities such as power and water have long been publicly regulated, and I can't imagine health care to be any less critical.
For now, the public should be concerned about how our current HMO payment system is corrupting the doctor-patient relationship. Doctors are only human; can you really trust the judgment of a professional who, because of the "system," is going to lose money every time he or she sees you? Correct this perverse arrangement, and your doctor may once again be happy to see you -- even if you happen to be sick.
Ron Adler, MD, a clinical professor of medicine at the University of California at San Francisco, recently left his Berkeley, Calif., practice in Berkeley at the age of 57 to pursue other interests, including teaching, consulting, and research.