Dear FRONTLINE, I watched your program with great interest, as managed care directly effects my job as director of optical services for a large opthalmological practice in Florida. Everyday, I am faced with making decisions of what "fat" to cut from my budget, without compromising the quality of patient care. Even with something like glasses, the number of restrictions placed on the provider, make it very difficult to offer quality products for what HMO companies are willing to pay. One of the issues we deal with daily, are patients who come into our offices expecting "everything to be covered, because the insurance agent who sold me the plan said it would be". We are now the bearers of the bad news about what is covered and what they will owe if they go out of their plan. In addition, we spend many hours of our day, listening to patients complain about how much they pay for insurance premiums and how their benefits are being cut. However, behind the scenes, we take cut-backs in order to keep this plan. Who benefits from these higher premiums? It isn't going for better care, but rather to produce greater profits for the insurance companies. The pressure to accept the plan or have your patients referred to another practice, is becoming greater everyday. The decision about a plan then becomes, can we afford to take on another plan, or can we afford to allow our patients to go down the street? This is not a decision to be made lightly. I feel very fortunate to work for a practice that still feels that the education of our staff is a high priority and has not been compromised, therefore, still allowing us to offer quality care to our patients who have come to expect nothing less. Thanks for informing the public of the problems we in health care are facing.
Tina Wood
framebendr.aol.com
Bradenton, FL
Dear FRONTLINE, An eye-opening presentation. I am on a Board of Directors for a mental health agency and we find ourselves preparing for the absolute worst. Without a doubt the care of our clients will be compromised for the sake of cost containment. Many of the mentally ill will wind up back on the streets. Most definitely, they will be unable to access the services they need.
Vincent Switzer
vincent.switzer@mci2000.com
Syracuse, NY
Dear FRONTLINE, I recently left healthcare after working in it for nineteen years. I was a middle manager in a technical area, and was involved in the cost-cuting process and wittnessed the chaos it produced. I'm relatively certain that quality of care was reduced. At this point, I feel that the only way to return medicine and nursing to their original, patient-oriented status is to eliminate the HMO organization altogether. One point that was missing in the program is that HMOs do not actually deliver health care; doctors and nurses perfom that function. The HMO and its business-like orientation has taken the focus of the practice of medicine off the very reason for its existence: the needs of the patient.
Alan MacRobbie
AlanMacRobbie@Worldnet.att.net
Rochester, New York
Dear FRONTLINE, For every complex question, there's a simple answer - and it's wrong. Is there an answer to the question of the high price of health? No single answer is possible for the many questions that exist - and as advances are made in treatment of illness, more questions will rise. I offer a question: what should health care providers do about the terminally ill, when family members refuse to accept that their loved one is dying? Can society be brought into the knowledge that at some point we all die? I am a nurse; I had this conversation with a house supervisor this weekend. We discussed an elderly female, in and out of the hosital for several years. From November 1997 until March 1998 she was in our ICU, being given iv antibiotics, on a vent, ulcers all over her body being dressed twice daily. Her skin broke down and could not heal. She could not eat and was fed by tube. She was on and off the vent because she could not breathe on her own for very long at a time. When she could, she begged us to leave her alone, even after she had been medicated before dressing changes. Doctors asked her husband and son about code status repeatedly: always the answer was no. It was known in November that she would never leave the hospital: lungs and heart were nearly gone. She suffered so, at our hands: who will answer for this? Did we do her a favor by extending her "life"? No one who cared for her believes this. She was tortured in the name of medicine. One possible answer to the high cost of medicine? Comfort care only or hospice care when it is absolutely agreed that the individual has no chance for recovery. We spend far too much money on futile treatment. Every nurse I know feels this way - and most have stories like the recent example above. It provides jobs - and makes money - but it is inhumane and insane.
Cedartown, GA
Dear FRONTLINE, Thank you for the excellent program about managed care. Patients need to be informed as to what managed care is doing to them and how their care is actually being managed according to the bottom line. If more people knew fully the extent to which managed care has gone to decrease the amount and quality of care they recieve, there would be an unprecedented uproar. It's easy to deny care when you are sitting behind a desk and looking at a flow chart, but it's you and the patient alone in the exam room and I'm the one that has to look them in the eye and say "No" If efficiency is truly managed care's goal, then obviously the most efficient system would be to close all the hospitals and clinic's and have people die at home alone and afraid. This would surely "maximize their profit margins."
Harry Rose M.D.
harry@sunlink.net
Danville, PA
Dear FRONTLINE, Managed care is not the irrevocable state of health care. There are alternatives to the current system, starting to proposed legislative measures to reform managed care. Visitors to this Frontline site may be interested in my Fight Managed Care! web site, which contains 200 true, properly cited, managed care horror stories. The site also has an updated journal of health care policy news and opinions. The site is at http://www.his.com/~pico/usa.htm.
Robert Raible
pico@his.com
Bethesda, Maryland
Dear FRONTLINE, I am a senior nursing student getting ready to enter enter the nursing field as a RN this May. I found this program extremely helpful in bringing all that I have learn in my "nursing management" class together. This program thouroghly shows the changes in which health care today is going through. I personally agree with the concept of the HMOs. I have my differences with also though. As a concept, I believe that all healthcare workers need to be concerned with the "waste of the past" in this area. As with all modern industries, companies, etc., costs need to be contained to meet the needs of tommorrow. The largest success we have had in this is from the use of service and product contracts. Costs need to be contained - we are not the government. Increased bargaining power will only help facilitate the future move toward there being only a handful of health insurance providers in America as predicted. I do however feel that in some cases this has caused a decrease in the quality of care. I find that HMOs do not have the personal involvement with the care of their represented clients most of the time. Health care providers all know that everyone is truely an individual. We may generally treat certain things the same, but everyone requires some individually specific care during their care. That is because everyone is their own biopsycosociospiritual being. The best thing that HMOs could do is to allow exceptions within reason in the care of their clients. People are individuals and some decisions are needed to be made individually.
Brook Roberts
broo3812@southwind.net
Hillsboro, Kansas
Dear FRONTLINE, The high price of health is correctly named. The problem with both the old system and the new is that the people directly affected by the heath care system (the patient) have abdicated their financial responsibility to Insurance Companies, Businesses and the government. Each of these groups are interested in only two types of people, the healthy and the dead. They have no vested interest that I can see in the well being of the average patient. If people expected to be compensated at a level that would allow them to save for their own medical needs, we would all be better off. I earn a better than average salary as a Systems Consultant and have raised three children. I have found that over the last several years the personal cost to me beyond what insurance covers has increased substantially. Deductibles, exclusions, and price caps now cost me between five and six thousand dollars a year in "out of Pocket" expenses. Good quality service is almost impossible to find even if you are willing to bare the cost yourself. The people who are suffering the most are the poor and the elderly who have no voice at all in the system. If we let HMO's continue to drive the best and the brightest out of the system it won't be long before we are going to be paying top dollar for mediocre care. I am not looking forward to the day when a stockbroker will be performing heart surgery on the side as a hobby. It may finally be time to plan a move to Canada or Europe, at least after I reach retirement age.
Gerard Lagorio
jlagorio@cobweb.net
Pittsburgh, PA
Dear FRONTLINE, I think that HMO's should be strictly regulated and should be a non-profit management corporation with Salaries of CEO's and top executives be level headed and not in the stratosphere as most are today and you have medical care being denied in this country to people that are paying large amounts of there paycheck each week to not be hassled. But when the care is needed they are directed to take the cheapest way out. The Health Care today in this country is becoming horrible and out of touch with the patients concern!!
Toms River, NJ
Dear FRONTLINE, Thank you Public Television and Frontline for a great job presenting a piece of the awful truth about what is happening to our health care in USA. Two groups are working hard nationally, but with less than enough publicity to get the word out the way PBS can do it. These two groups are PNHP, Physicians for a National Health Program and UHCAN Universal Health Care Access Network, with chapters in nearly every state. PNHP does the professional and scholarly research and publication of the story as it unfolds nationally. UHCAN is the grass roots organization of folks like you and me, meeting, studying to learn the facts, donating our lives, our fortunes, and our sacred honor to save the best health care providers in the world from the greedy grasp of Wall Street. We've been working quietly, but the word is getting out. Tell your doctors you want them to decide your care, not some clerk on a phone in an insurance company. Join the groundswell round swell of awareness that there is a crisis and there is an answer. It is single payer and it costs less than our present system. It is not socialized medicine. Doctors and providers are independent, not employed by the government. It is not "Managed Care". Health care providers, not insurance executives, make clinical decisions. It is not corporate medicine. It is not profit driven. Fact: It will deliver quality healthcare to all from birth to death & it cannot be cancelled. Fact:Patients will have more control over their choice of physicians. Fact: It will gratly reduce administrative cost, which means more money put toward providing care. Fact: US is only industrialized nation that does not have a system of universal health care. For info:PNHP-332 So. Michigan, Chicago, IL,60604 312-554-0382////UHCAN 313-8846 Robindale,Detroit, MI 48239--313-531-2136. Universal Health Care Access Network has local chapters across the country, like MichUHCAN based in Dertoit. For information write to MichUHCAN at 8846 Robindale, Detroit, MI 48239 or call313-531- 2136. Physicians for a National Health Program -PNHP- is a high level, fully professional source for facts about what is wrong with a For Profit Health Care system. It is based in the medical community in Boston. For information call the Chicago office at 312-554-0832. Both groups say: A single payer system is the answer and it costs less than our present system. Thank you Frontline for giving major media attention to this urgent matter. We seniors recall the stock market crash in 1929. Let's not let Wall Street CRASH our health care system. Wake up, America, before you lose your doctor,your health, and maybe your life on the sacrifical altar of the ALMIGHTY DOLLAR !
Isabel Doyle
iamdoyle@juno.com
Birmingham, Michigan
Dear FRONTLINE, I work in the healthcare field handling insurance claims for a large clinic. Managed care comprises a large part of our business. I am well aware of the cutbacks and care dictated to physicians by insurance companies. Fortunately, my family is on a PPO and we do not face the problems the occur with HMOs. Unfortunately, my daughter is on an HMO. I would like to tell you her story. She has a 10-month old baby boy. Since the baby was born, he has had an increasing problem with severe eczema which the primary care physician has treated and chosen not to refer him to a dermatologist or allergist. He has also had severe reflux. Two months ago, he was seen by his PCP on the verge of severe dehydration. His parents were told he was on the verge of dehydration but "let's wait six more hours and see how he responds". It became evident that this child could not wait six hours for the physician to admit him to the hospital. Instead, the physician was contacted and bypassed by way of the hospital emergency room. The ER physician indicated the baby should have been seen much sooner and he was admitted for severe dehydration for 3 days. One of his nurses could not understand why we had waited so long to take this poor baby to the hospital..... but her first questions to us was "Are you on an HMO?" When we told her yes she indicated that was the reason why he was not admitted sooner by his PCP. As the grandmother and one familiar with this bureaucracy, I convinced the PCP to contact a dermatologist to see the baby in the hospital. She agreed to do that and we saw a dermatologist. After 3 days he was discharged. Four days after discharge the exact same thing occurred but this time the baby had aspirated vomit. He was again admitted to the hospital, thru the ER again bypassing the PCP. He was severely dehydrated and had pneumonia. The PCP wanted us to wait again before going to the hospital but we had learned our lesson the first time. This hospital stay required 4 days. After much discussion with the PCP, the child was referred to a Pediatric Gastroenterologist at Texas Childrens Hospital who was a godsend. He was able to get to the root of the problem - congenital stomach problem as well as severe allergy to protein. He was given a prescription for Neocate, a predigested baby formula. It requires a prescription and cannot be purchased over the counter but requires special ordering. With a letter of medical necessity faxed to the HMO indicating in order for this child to survive it was necessary for him to be placed on this formula, we received our first denial. The formula is approximately $20-30 per can which lasts approximately 1 week. Understanding the way of appeals, I then submitted a letter for the child, signed by his mother, with additional explanation for the need of this formula. We were given the runaround. The PCP did NOT get involved in this, al- though she is supposed to be "managing" this child's care. I then had my daughter contact the employer thru which they have the insurance. They got involved and after much unneeded delay, the formula was approved. The baby has gained back all of the weight he lost and is doing very well. Un- fortunately the eczema continued to be a problem and the PCP finally agreed to refer to an allergist. The eczema as treated by the allergist looks to be a thing of the past. After being involved in such a horrendous occurrence with my first grandchild, I am unhappy with a PCP that wants to hold off until the last minute to admit a seriously ill child to the hospital because it is going to hit her pocketbook. What happened to the Hippocratic Oath she took when she became a physician? I am appalled that an insurance would deny a necessary prescription to a baby that is not thriving and will most certainly die if not given the proper nutrition. We had a second opinion outside of the HMO and were told if this baby was not able to overcome the chronic acute malnutrition he was suffering, that he would not survive. Do the HMO's not have a conscience or do they just see dollar signs? Again, I work in the healthfield. My daughter had no idea how to fight to get referrals or her prescription. Had I not helped her, I cannot say what may have occurred. I believe physicians need to take a look at why they became physicians and those doctors turned "big business" should no longer be allowed the privilege of being called a doctor. In my book, a doctor is someone who cares for the sick and does not allow money to determine the quality of that care. Although that cliche may be overused according to the physician in your program, I believe that money is the determining factor in many cases as to the type of care a patient receives. Doctors and those "doctors" managing HMO companies need to go back and read the Hippocratic Oath and do some soulsearching or they do not deserve to be called Doctors.
Roberta Elmore
roberta_elmore@hotmail.com
Conroe, Tx
Dear FRONTLINE, Congratulations. This is television at its best. You have revealed the brutality in a system that is fundamentally designed to be humane. When medicine becomes health care, physicians become providers, and the sick become economic burdens, our values as a nation are questioned. We will all be patients someday.
Fred Milller
AFMiller@aol.com
Boxborough, MA
Dear FRONTLINE, As an RN who also went to business school, I understand the pros and cons of managed care. I agree that medical resources have not been very effeciently used in the past, but replacing the old system with one that is ultimately driven by shareholders' demand for profit is simply another kind of mistake; a pendulum swing in the opposite direction. For-profits are obliged to advocate for their shareholders in their dealings with both patients and patient care providers, and deal punitively with those who challenge them. In this environment, can anyone advocate effectively for patients? I doubt it. That is largely why I am no longer a practicing nurse.
Janet Michaelis
janmic@erinet.com
Dayton, OH
Dear FRONTLINE, Thank you for this informative, sobering program. I was a supporter of Bill Clinton's efforts to restructure the country's health care system several years ago. I was disappointed with the complexity of his proposal, but outraged by the way that the entire health care industry snarled and spit like a rabid dog at the idea of change. As I remember it, the ads and spin from the industry tried (successfully) to frighten the public at the prospect of not being able to choose our own doctor, or get the treatments we might need because of a vast government beaurocracy. Aren't these the very things that have come to pass with managed care? The only difference is that a few people have gotten incredibly wealthy by preying upon the health "consumer".
Stephen Fox
docfoxhead@aol.com
Brooklyn, NY
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