Demonizing HMOs

COMMENTARY Health Care Reform

Demonizing HMOs

Feb 25th, 1999 3 min read


To get something done in Washington, it helps if you have a villain. That's why the coming debate over a "patients' bill of rights" will feature attempts to portray HMOs and other managed-care companies as the scourge of the American health-care system. There's just one problem: The American people in whose name HMO "reform" will be pursued are generally happy with their health care.

This is true even among those in managed care. A 1998 Washington Post-ABC News poll found 80 percent of HMO enrollees "satisfied" with their plans. And more than four out of five respondents to a 1998 CNN-Time Warner poll said they experienced no problems with access to emergency care, medical care generally, or treatment by specialists.

Of course, imposing new regulations on managed-care companies-which is what the "patients bill of rights" is really all about-requires convincing Americans they were mistaken when they told pollsters they liked their health care. Only by demonizing managed care can politicians and interest groups gin up the kind of public outcry necessary to spur government action.

So as the debate heats up, expect to hear more outrageous anecdotes about abuses by HMOs. Indeed, some politicians would have us believe that patients are carted from recovery rooms to curbsides. And when legitimate "victims" can't be found, they are created.

What this debate will need is a healthy dose of fact-checking by the media. For example, one well-known HMO "horror story" involved Helen Garvey, a managed-care enrollee who died of complications from a rare and serious type of anemia.

Initially the media portrayed her as a victim and blamed her HMO for refusing to authorize emergency "out of network" care. But Howard Kurtz, the media critic for The Washington Post, did some digging and discovered that Garvey had ignored her health-plan doctor's advice to come in for blood tests before leaving for her Hawaiian vacation. When it turned out she needed an immediate bone-marrow transplant, her health plan dispatched a nurse thousands of miles to accompany Garvey to a major transplant facility in Chicago. (The hospital in Hawaii did not perform bone-marrow transplants.) Sadly, she suffered a stroke during her return trip and died nine days later.

Similar examples of politically motivated fabrications abound. Take the so-called "gag rule." HMO doctors are supposedly prevented from discussing treatment options with their patients unless those treatments are covered by the managed-care provider. But a recent audit of more than 1,500 HMO contracts by the General Accounting Office, the research arm of Congress, was unable to turn up even one example of such a restriction.

Still, proposals to regulate the health-care system even more strictly continue to pour forth from politicians. Some lawmakers are suddenly experts on the appropriate lengths of hospital stays and standards of care-amazingly, without any medical training. For example, recent legislation mandates to the hour the amount of inpatient care health plans must provide for women undergoing mastectomies. Never mind that major cancer and surgical journals found no greater complication rates with shorter hospitalizations following certain types of mastectomies.

Then there are mandates prescribing how long new mothers should stay in the hospital after giving birth. The fatal conceit behind such regulations is that politicians know better than doctors how long patients should remain hospitalized after various procedures. They don't. Indeed, it's insulting for politicians to imply they know more about medicine, or care more about

patients, than the doctors whose sworn oath it is to "do no harm."

All of this is not deny that some Americans are dissatisfied with managed care. But the solution for those who are is not more regulation, it is eliminating the hurdles that prevent people from purchasing a health plan more to their liking. Right now, most Americans get their health insurance through their place of work largely because employer-provided coverage is tax-free. A family would be penalized hundreds of dollars a year if it bought coverage on its own. Congress should end such barriers to consumer choice.

Meanwhile, President Clinton continues to push for new regulations on managed care, and Congress seems more than willing to go along. The danger is that lawmakers will base their "reforms" on distortion and exaggeration-scapegoating managed-care companies and sidestepping the real problem.

Note: Sandra Makhorn, M.D., is a visiting fellow in health policy at The Heritage Foundation (, a Washington-based public policy research institute.

Distributed nationally on the Associated Press Wire

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