Molly Ivins November 6

AUSTIN — Three years ago, when President Clinton proposed that we do something about medical care in this country — specifically, provide universal health insurance — the forces of reaction raised a great alarm: "Socialized medicine is coming! Socialized medicine is coming!" So socialized medicine was defeated, and we got corporatized medicine instead. And aren't we all happy with corporatized medicine? Isn't this fun?

Doctors in Dallas are fined by their health maintenance organization for ordering "too many" prescriptions. Your health insurer decides that a crucial treatment is not "medically necessary," and you have no recourse. "Gag clauses" keep physicians from speaking freely about available treatments. Twenty-four-hour limits are put on hospital stays for new moms. HMOs push doctors to use cheaper drugs. Big corporate bonuses go to HMO officials. Ain't it grand?

According to U.S. News & World Report, managed health-care plans in many markets are being threatened by competition, so they cut patient services and try to lower costs even more. Even the non-profit HMOs are being whacked for putting the bottom line first to stay competitive.

As reported in Newsweek, consultants are going around the country, showing institutions how they can increase their profits by hiking Medicare claims. Abuses are such common occurrences that many health-care institutions are simply planning for these possible fines when setting their budgets. Yes, indeed, this corporatized medicine is dandy stuff.

U.S. News & World Report recently collected a few examples: "A young mother in California dies because her HMO delayed referral to a specialist. An elderly man in Florida, grieving over his wife's death from a cerebral hemorrhage, is stunned by a $30,000 bill from his HMO says he must pay because he failed to get emergency-room authorization."

You can find horror stories like that in the papers almost every day. In April, says U.S. News, the Texas Department of Insurance fined Kaiser Permanente $1 million after investigators found "unacceptable disregard for quality of care," such as denial of payment for emergency care of a patient in diabetic shock.

According U.S. News and World Report, HMOs have "developed standard procedures that doctors are expected to follow for specific diseases." If your case doesn't fit the standard, you're out of luck. "Utilization review panels" go over "patient records and decide what treatments the health-care plan will cover." Love that corporatized medicine.

The poster boy of corporatized medicine is Columbia/HCA Healthcare Corp.

It has set records that other corporations are scrambling to emulate. The company went from owning six hospitals in Florida to 67 in just four years — one out of every three beds. According to Newsweek, Columbia poured lobbyists into Tallahassee and profoundly altered the practice of medical care in Florida. Patients were transformed into centers for profit; their illnesses turned into product lines. Columbia allegedly offered physicians equity partnerships in exchange for referrals. Wall Street loved it; the company's net worth soared to $20 billion.

Of course, Columbia/HCA is now under investigation by both the feds and the state of Florida on allegations of massive fraud, but hey, "corporate ethics" is an oxymoron anyway. What did you expect?

According to The New York Times, a 1995 survey by the Pew Charitable Trust and the Harvard School of Public Health found that 55 percent of the doctors surveyed say the health-care system is deteriorating overall, and doing so most sharply in areas with well-entrenched managed health-care organizations. The system has shifted decision-making power from doctors to health-care administrators, whose bonuses depend on cutting costs.

The almost $1 trillion that Americans pay for health care no longer just pays for health care — it goes to mounting marketing costs and stockholder dividends. You against profits or something? It's the American way, Bubba: Everything for sale.

Well, now — all this does seem to call for a little (oh, how I hate to use this word) regulation. I know, I know — government regulation is just a dreadful thing, and all the right-wingers tell us that the magic of the marketplace works so much better. The Republican Party has been carrying on about the evils of regulation for so long that half the people in the country think their government shouldn't even regulate for health and safety, much less to prevent rip-offs or save the environment. Still, three of the nation's most prominent non-profit HMOs, with 10 million members, have sought regulation from the government. Naturally, the trade association of the for-profit HMOs is opposed.

What you want to remember as you watch this battle play out in Washington is that the decisions are being made by members of Congress, who themselves enjoy a pure system of socialized medicine. All their health-care costs are paid for by the taxpayers. Senate Majority Leader Trent Lott and other Republicans are already opposing regulation of HMOs; you also want to watch their campaign contributions from the big-money health-care systems.

Am I suggesting that such a paltry thing as mucho moolah for the campaign coffers would actually affect their decision on life-or-death issues for American citizens? Yes.

***

Molly Ivins is a columnist for the Fort Worth Star-Telegram.

COPYRIGHT 1997 CREATORS SYNDICATE, INC.