Dear FRONTLINE,

ENOUGH ALREADY!! Yes, managed care looks at saving costs. So what? Why would anyone want to pay too much for anything? Will doctors do the job for less? Doubtful. What did indemnity do for us? Paid claims with no questions asked, no interest in whether the care being provided was of quality, much less necessary. This ignorance is exactly what led to skyrocketing health care costs that have since been taken on by the managed care industry. My HMO has tracked my health for 15 years, and reminds me to get preventive visits, sends me educational materials, has an incredible wellness program, puts on community outreach programs, etc. The list of good they do is limitless -- yet no media outlet will cover these topics. They're not "sexy" or inciteful enough. PBS, what about you? Why hop on the bandwagon and continue to rehash the anecdotal horror stories? Rather, why not explore the myriad examples of HMOs' efforts to improve the quality of care? And the ultimate question? What's YOUR solution?

Barbara Byers
birish1@aol.com
Buffalo, NY

Dear FRONTLINE,

Watching your program this evening on Channel 56 I learned that this is happening every where. I have been one of those people who have been trained to take over a RN's job. I think the responisablity we have now is way out of control. I work at a hospital here in Oakland county that has just went to this program. They say it's about not making enough money so cuts have to be made. What they forget to tell the public is that the big wig of the hospital got a 1.5 million dollar bonus last year. Why not give him a pay cut. It's us little people that make the hospital run. If it wasn't for us no money would be made, But look who's pocket they cut (ours).The people who are suffering are the patients. There are more complaints on a daily basis about how they haven't seen there nurse all day. Patient care has gone down hill and will continue until this can be stopped. It's all about the rich getting richer not the patients getting better.

Kimberley Miller
Lhrk@aol.com
White Lake, Mi

Dear FRONTLINE,

The growth of managed care is, in part, due to out-of-control costs in health care and the government's inability to properly address the problem. While moderately successful in controling costs, managed care has handed the control of health care to non -clinical personel. We should not be surprised that this has changed objectives for delivery organizations. Doctors and nurses have extensive training in patient care. Businessmen and administrators are trained to expand the bottom line. Did we really expect anything different? I can tell you from personal experience since I am both a medical student and administration student at the present time. The conflicts of interest between these two ways of thinking can often be astounding.

Ypsilanti, Michigan

Dear FRONTLINE,

I have been anxiously awaiting this program because I was recently diagnosed with a potentially life-threatening disease. I have already been refused some coverage by my insurance company. It should be patently obvious that no one's health should be sacrificed to profit. The concept of "coverage" should be abolished. Everyone should have access to all needed health care. I wonder how Dr. Malik Hasan would feel if he were in very bad health and he had insufficient "coverage" to save HIS life. But then he seems to be such a sociopath (looking forward to the "fun" of cutting back on his company's "services" in search of even more profit), he probably would enjoy dying.

Robyn O'Neill
teanga@aol.com
New York, NY

Dear FRONTLINE,

I have a daughter who after being out of nursing for a number of years went back in to the hospital setting. She found herself with 14 to 16 patients and working a 12 hour shift. She had to be at work at 6:45AM and would not get off work until 8PM on many occassions. This was because of the heavy workload of patients and trying to be a good nurse to all of them. She found it very difficult to give the type of care she was trained to do 20 years ago. Patient care is definitely suffering with the managed care system. I pray we can get back to the way it used to be and Dr's can administer care as well as nurses.

Nashville, TN

Dear FRONTLINE,

I just watched your program on "Managed" health care. What a depressing program. Despite the assertions of the managers, that were defending this health care by spreadsheet, the unassailable fact remains - you get what you pay for (if you're lucky). When physicians act like accountants they should become accountants and leave health care to those that care.

From my perspective Malik Hassan is the archtypical short fingered vulgarian, amassing a personal fortune on the misery of his clients. His assertion that HMO's provide the highest quality care for the lowest cost is at its most generous an oxymoron. If this were true, than we could extend this argument to assert that you can purchase a Rolls Royce for the cost of a Yugo. It would be more honest to say that you get the quality of care that the HMO is prepared to pay for.

Caveat Emptor!

Dennis Csatari
csatari@globalserve.net

Dear FRONTLINE,

Your program was wonderfully done and very informative. It portrays the negative sides of the trend in health care financing that are facing us all. While you did touch upon the subject, i feel that there is another side to this story. For every patient denyed payments for a heart transplant, for every well intentioned physician who is attempting to use his skills as best he can, there are other care providers irresponsibly wasting healthcare dollars. Over dispensing of prescription medications, over utilization and inappropriate use of technology, and other inefficiencies waste billions of dollars that could be far better used. I think you also neglected to touch upon the fact that those responsible for buying these offensive health plans share in the blame for what our system of health care is becoming. The old phrase you get what you pay for can be readily applied to health plans and insurance. It is sad to watch a physician operate with his hands tied and waste time doing cosmetic procedures when his heart lies in far more important pursuits. Thanks for a great program.

Tony Badalamenti
ambadcar@msn.com
West Islip, NY

Dear FRONTLINE,

The high cost of health care that alleged managed alleged care claims to be "managing" is not a decrease in the cost of health care. Any dollars "saved" by increasing work loads and reducing both quality and quantity of care are being sucked up to the CEOs and their MBA minions. In the process they, the MDs and the RNs, and the patients are becoming the servants rather than the managers of this economic flip flop. We used to live in a society where the economy was a tool. It's been turned inside out, and upside down. The economy now controls the society, and what we've been told for 15+ years will trickle down from the "supply side" is now defying gravity and pouring up and into the pockets of BUSINESS people who, in order to operate in this economy-ruled society, *think* they must sell out to greed. They describe it with words like "efficiency" and "just business" and "my job." They tell is that managed care is just the way it is. It wasn't the way it is until BUSINESS *made* it the way it is.

Because I am aware of how greed can obliterate integrity, fuel mendacity, and motivate downright barbarianism -- and because I've been exposed to too much of that from and within the rapidly fragmenting medical "culture" already --

Minneapolis, Minnesota

Dear FRONTLINE,

The problem with managed care has to do with incentives. Since most managed care is purchased by companies interested only in reducing costs, costs are what HMOs focus upon. If consumers themselves made the purchasing decision, both the care and the cost side of HMOs would receive proper attention. How great would it be if we had a Schwab style supermarket for HMOs.

Gary Davis
gfdavis@ix.netcom.com
Stamford, CT

Dear FRONTLINE,

I am a board certified physician who does not accept managed care. I will not allow insurance companies to decide what my patient's medically need. I trained over 13 years to learn what a patient needs. I refuse to sacrifice trust and quality to make profits for people like Mr. Hasan. We need to get the word out to the public about Medical Savings Accounts (MSAs). MSAs restore personal choice to the patient. The patient decides how to spend their healthcare dollars, not Mr. Hasan who rations care. Medicare is making available MSAs to recipients in 1999. This is a pivotal for medicine. Are we going to allow corporate American to drain the profits out of healthcare while sacrificing patient care? The public needs to say no. If they wait until it personally affects them, it will be too late. This is not an exaggeration.

Shelley Giebel
giebel@vvm.com
Belton, TX