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Tue Feb 11, 2014, 07:33 PM

Damaged Care Redux: "They're Back!"

In 1999, under my maiden name I published a short book about so called managed care---"Damaged Care" as it was sometimes called at the time. HMOs or Managed Care failed due to physician and patient concern that they were damaging the doctor-patient relationship and leading to poor quality care. In particular the idea of paying doctors NOT to provide care or to turn away SICK people did not set well with many people---including doctors. Laws were passed to prevent HMO abuses. Most people dumped their HMO for a PPO--a plan that provided better payment for in network providers but had an out of network option as well.

Well, don't look now, but the economic forces that lead to the creation of HMOs are in play again. Insurers now must take all comers, regardless of pre-existing conditions. They can no longer "cherry pick" healthy people in the individual markets. If your aunt on dialysis wants to sign up for United Health, she can. If your brother who is on a liver transplant list decides to pick Blue Cross, Blue Cross is stuck with him.

Since insurers make money in only one way---by collecting more in premiums than they pay out in benefits--the ACA puts them at tremendous risk. And risk is something that the health insurance industry does not want. In order to cut its losses, the industry will try to do what it did in the 1990s---limit care, drive away the sick, make it difficult for doctors to care for those who need care the most. Their goal is to make all the sick people abandon ship while keeping the healthy members happy. Their ultimate goal is to force all the "sick" people on government funded Medicare and Medicaid while collecting federal payments for healthy people. How do they hope to accomplish this? The same way they did it back in the 1990s.

Some things have changed from the 1990s, but some are all too familiar. People who are trying to use their shiny, new silver plated insurance for the first time are discovering that their specialists are NOT on their plan (they were promised that they would be). If they belonged to an HMO in the 1990s and if they had read my book back then, they would not be surprised, because they would know that "Member Services Always Lies." They are beginning to realize that finding doctors and providers on their new insurance can be difficult if not impossible. There are new rules and regulations that make so sense. Barriers to care are thrown up that seem to serve no purpose except to frustrate and frighten patients--and that is exactly what they are trying to do. Scare away "sick" people while keeping the "healthy" folks happy. Insurers have found new ways to reward doctors for treating only the healthiest patients--they call it "Pay for performance". And since "poor" often equals "sick" in this country, one way they can limit their liability is by having only a limited number of doctors and providers that serve in poor or minority areas.

After reading about some early bad experiences that people are having in California, I decided to revise and update "Damaged Care" for the 21st century. Some parts are left out. Some are modified. New sections have been added to address issues that are unique to the ACA. The book, "Damaged Care Redux" is now available in electronic form now for FREE at Amazon at http://www.amazon.com/...

If you do not have a Kindle and can not download Kindle books on your computer, send me an email at McCamyTaylor@earthlink.net and I will send you a Word manuscript at no charge. If you want a copy of "Life After CPAP" I can send that, too.

I am a family physician with a Master's Public Health. I work in a public clinic for the uninsured but I see a lot of so called Medicare Advantage Plan patients too, because their insurance does not have enough doctors to meet their needs. Pretty sad when someone with insurance has to rely on a clinic for the uninsured to get care.

Remember, an informed consumer is a healthier consumer.

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