HMO Found Responsible for Suicide

Marta Russell ap888 at
Fri Oct 30 14:14:21 PST 1998

Fellows, Jeffrey wrote:

> Thanks Marta for the post. Although I think the decision is a good one - I
> believe that HMOs should be held accountable - the issue of extending legal
> liability to organizations for the poor care they provide can have some
> serious unintended consequences. For instance, a result of this process
> could be a drive to have organizations "licensed" in the same way physicians
> and advanced practice nurses are. As part of my dissertation on the
> proletarianization of physicians I noted that the issue of licensing
> organizations and not providers has already been put out (I doubt anyone was
> listening besides me). I could certainly envision that HMOs would want seek
> to change practice licensing laws if they are to be held legally liable for
> malpractice. In such a scenario, the shift away from docs and to HMOs could
> radically weaken physicians' and other providers' medical decision-making
> power. Thankfully, I think the public would never go for it, but you never
> know. The social and political attacks on providers over the past 30 years,
> led largely by financial capital interests (insurers) has had a significant
> impact on public perception of physicians.


The attack on providers has also backfired on the capitalists. I think that people are much more keenly aware now that HMOs make decisions for their bottom lines and the patient is the one to pay the price. Doctors have wisely begun to assemble groups who criticize the usurpation of health care decisions by the HMOs. There is great opportunity to do this, HMO horror stories are abundant.

For chronically ill people and pwds the payment paradigm shift from fee for service to managed care has had enormous consequences. When a pwd saw a doctor under the traditional system that doctor got paid for the visit; under managed care there is a set fee no matter how many visits a person may require. Yet there is no question that billing rates of physicians and hospitals under fee for service went way beyond the pale. Doctors could count on an enormously inflated income and we know that not all treatment decisions were being made independent of profit motives there either.

Some HMOs are cancelling Medicare contracts because - guess what - elderly and people with disabilities (pwds) need more care and that takes away from their profits. If anyone was in doubt before that HMOs want only "healthy" ie low cost enrollees, they are showing their true colors now.

We still have a medicine-is-money society, we have not erased the profit motive by shifting to HMOs, and we all know the reasons why not. Personally, I would like to see HMOs collapse. I certainly don't want to see any licensing.


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