The HMOs are mad as hell and they’re not going to take it anymore. They know they’re doing a good job (all of their feedback data tells them so) yet they are under relentless attack in Congress, in the state legislatures and even in the movies.
What to do?
This was the big question at last week’s HMO industry convention in Boston. What to do, for instance, about trial lawyers who are lobbying Congress to make it easier for dissatisfied HMO customers to sue their health plans, the majority of which are now protected from liability lawsuits by a federal labor law called ERISA.
What to do, also, about angry doctors–doctors who don’t like being second-guessed by HMO medical directors or being excluded from a managed-care plan because they charge too much or make too great a use of expensive diagnostic tests.
And most of all, what to do about all those angry people. These are the people who, when surveyed, say they like their doctor and their HMO, but want government to do something about all the greedy, profit-driven HMOs, like the one that wanted to amputate someone’s bad leg because it was cheaper than the cost of orthopedic surgery and follow-up physical therapy. What to do, indeed, when Congress is poised to remove that ERISA liability shield, and when dozens of state legislatures either have, or are about to, pass HMO reforms that would do any number of things. There are bills out there that do everything from mandating coverage for chiropractic to enabling any doctor to join the “approved” list of any HMO.
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So the HMO executives gathered last week at the annual meeting of the American Association of Health Plans and they listened to speaker after speaker tell them how to improve their image.
Robert Blendon, a health policy professor from Harvard University, told them that public opinion about HMOs, like public opinion about airline safety, is not driven by personal experience but by dramatic events. All it takes is one ValuJet-type disaster, he said, and the public will demand “reforms” even if all the statistics are in an industry’s favor. “Most Americans can’t compute a percentage rate,” Blendon said. “Most don’t even know the difference between a savings and loan and a bank.”
Convention organizers even brought in a pair of Washington-based political strategists for a session titled “How to launch a press offensive.” These guys took an even dimmer view of the public’s ability to distinguish between everyday results and a scary anomaly. “You’ve got to develop some sharp-edged stuff of your own,” urged Michael Murphy, one of the spin masters. “Make it good versus bad, us versus the greedy trial lawyers.”
The problem with this sort of advice, of course, is that it badly underestimates the ability of the American people to figure things out for themselves. Were it followed, it would put managed care in the same mud pit as its opponents, slinging gobs of juicy anecdotes about greedy MD specialists and mega-buck malpractice lawyers.
My advice, offered last week at no cost (and worth every penny) was that HMOs should have their side of the story ready when the press calls with a horror story (The amputation authorization was a mix-up caused by a hostile doctor out to make a point) and to worry more about the “little things” that drive customers crazy. Things like forcing enrollees to spend hours on the phone obtaining referrals from their “gatekeeper” doctor to a medical specialist or for advanced diagnostic tests.
Most of all, I told the HMOs to get out there and manage care, not just expenses. Make sure the babies are immunized, the kids are vision-tested and that middle-aged men and women are screened for colon and cervical cancer. Let the Old Guard doctors and trial lawyers find all the so-called horror stories they can. People aren’t stupid. The marketplace will go on choosing managed care (some 60 percent of insured workers already are enrolled) because it’s holding down costs for employers and because the vast majority of its customers are satisfied.
As for that waitress who curses her HMO in the movie “As Good As It Gets,” (often triggering wild applause) the scriptwriters missed the point. Most waitresses in America are among the 43 million who don’t have any health insurance.
Pray the media eventually will wise up, get on that story and cool it with the HMO horror tales.