Healthy disrespect for managed care

TRIGAUX E-mail: Click here Archive

By ROBERT TRIGAUX

© St. Petersburg Times,
published September 5, 2001

When the dog bites, when the bee stings,

When I'm feeling sad.

I simply remember my HMO plan

And then I feel twice as bad.

-- What Julie Andrews would have sung in The Sound of Music had she been covered by an HMO.

The good news is that I told the doctor I was covered by an HMO and he still agreed to see me before next year.

The bad news is he's a veterinarian.

HMO jokes are proliferating. But there's a therapeutic reason.

Managed care plans are getting so dreadful that it's healthier for the spirit to lampoon HMOs' dwindling services and rising costs. It sure beats crying.

Heard this one? The problem is that 99.99 percent of the HMOs make a bad name for the rest of them.

Too bad that joke's not as far from the truth as it should be.

Lawyers, banks, pharmaceutical companies and even the U.S. Postal Service do a better job serving consumers than managed care plans, says a new survey of privately insured Americans ages 18 to 64. In the survey, released last week by the Kaiser Family Foundation and Harvard University School of Public Health, 46 percent said HMOs and other managed care plans are doing a bad job serving consumers. (See table, left.)

The dissatisfaction is up dramatically from 25 percent of consumers that gave a thumbs down to their health plans in a similar Kaiser Family/Harvard survey in 1997.

Only oil companies rated lower than managed care in the public's esteem, according to the annual survey, which questioned 1,205 adults this summer.

Such a decline in satisfaction suggests there's a potential meltdown looming ahead in the U.S. work force.

Year after year, workers covered by managed care plans feel they are getting ever wimpier medical coverage at a higher cost. Workers look at their modest annual raises, then deduct their higher out-of-pocket medical expenses. Suddenly, that raise looks rather tiny if it doesn't disappear altogether.

Another recent survey of 10,000 employees at 18 companies, this one by consulting firm Watson Wyatt Worldwide, indicates U.S. companies suffer credibility problems with their employees. The survey showed only 48 percent trust their employers to design health plans that will provide the coverage they need. And 47 percent believe better plans are available for the same cost.

The situation will soon worsen. Florida is one of six states (including Texas, New Jersey, Ohio, Iowa and Alabama) that are expected to have the biggest, double-digit HMO premium increases for 2002, according to Managed Healthcare Market Report.

No wonder we're resorting to HMO humor.

Q: Will health care be any different in the next century?

A: No, but if you call right now, you might get an appointment by then.

In the Kaiser Family/Harvard survey, nearly half of the adults said they have had a problem with their health plan during the past year. Their problems ranged from delays or denials in their coverage or care (13 percent) to billing problems (13 percent) and difficulty seeing a physician (10 percent).

But 62 percent of those in non-HMO (and typically more expensive) health plans still gave grades of A or B to their coverage.

Those covered by HMOs, the strictest form of managed care, were far less generous. Forty-one percent of those covered by an HMO gave their plan a C, D or F grade.

According to Kaiser Family Foundation, most people say HMOs and managed care have (1) decreased the amount of time doctors spend with patients, (2) made it harder to see medical specialists, (3) not made much difference to health costs, and (4) decreased the quality of care for people who are sick.

"On all these measures, the public is as negative or more negative than in 1997," Kaiser Family says.

Poor Kaiser forgot to praise HMOs for what they do best. Putting customers on hold. Sending duplicate bills.

Q: How do you know you've joined a cheap HMO?

A: The only expense covered 100 percent is embalming.

Even doctors are starting to rebel en masse against HMOs. Last week, the 16,000-member Florida Medical Association joined a federal lawsuit in Miami filed by doctors accusing eight health plans of racketeering, fraud and extortion in cheating the physicians out of more than $1-billion. (HMOs deny wrongdoing.)

All of this is happening while Congress debates whether HMO members should have a right to sue their managed care plans. A Democratic Senate bill makes it easier to file lawsuits, while a Republican House version is more restrictive.

Most Americans apparently want the right to sue, but not if it results in companies dropping health coverage or sharply raising premiums. Only 58 percent in the Kaiser Family/Harvard survey said they would support such a bill if it caused their family's premiums to rise by about $20 a month.

Let's hope that the next survey does not bump HMO satisfaction below that of oil companies.

Surely managed care plans should aspire to the same level as, say, lawyers?

Until then, laughter's the best medicine.

Q: What's another way to know you've joined a cheap HMO?

A: The 24-hour claims line is 1-800-TUF-LUCK.

- Robert Trigaux can be reached at trigaux@sptimes.com or (727) 893-8405.

© 2006 • All Rights Reserved • St. Petersburg Times
490 First Avenue South • St. Petersburg, FL 33701 • 727-893-8111

Contact the Times | Privacy Policy
Standard of Accuracy | Terms, Conditions & Copyright