As the debate over healthcare reform really gets going, DrRich would like to put to bed, once and for all, one minor point that keeps being raised by supporters of the Obama plan. Namely, that it’s ethically reprehensible for HMOs to take profits out of the healthcare system.
This point, of course, is entirely moot today, since private insurance companies have completely thrown in the towel, and have publicly voiced their support for the Obama plan (along with the other major stakeholders such as the hospital associations and physician groups like the AMA and ACP). So for supporters of the Obama plan to harp at this late date on the profits these companies once enjoyed is a great waste of rhetorical ammunition. Better to keep your powder dry, and husband your moral indignation for battles you still face, such as attacking the moral status of entities who will pose a much greater threat once the Obama plan becomes law, entities like the obese, the elderly, the sedentary, and the habitually ill.
But DrRich’s concern here is neither to defend the moral integrity of HMOs, nor to advise Obama reformers on a more effective political strategy, but rather, is for simple historical accuracy. For HMOs, as evil and as reprehensible as their behavior surely was, were simply doing exactly what we deputized them to do, which was, to covertly ration healthcare. And this was a job that deserved to be well-paid.
This was hard, grinding work that was destructive to the very soul, and that ruined many formerly good people. As dirty and ugly a job as this was, somebody had to do it. So we hired the HMOs to do it for us, and furthermore, to be as unobtrusive and quiet about it as possible, so we wouldn’t have to think about it anymore. And for 15 years that is what they did, and they did it well.
For those who are still skeptical about what we actually hired HMOs to do, DrRich refers you to the case of Pegram et al. vs. Herdrich.
Ms. Herdrich was an unfortunate woman whose appendix burst after her HMO doctor, who was under strong financial incentives not to spend money, unreasonably delayed ordering the appropriate diagnostic tests. One might plausibly argue that her misfortune stemmed less from the results of this awful medical event (from which she apparently recovered, after much pain and suffering), and more from the advice she apparently received from her attorney, namely, to sue the HMO rather than the doctor.
After a long, protracted series of appeals and counterappeals, the Herdrich case eventually got to the U.S. Supreme Court. And the Supremes in 2000 unanimously found against Ms. Herdrich, and for the HMO. Justice Souter wrote the opinion for the Court, in which he said:
Like other risk bearing organizations, HMOs take steps to control costs. [Among these] are specific financial incentives to physicians, rewarding them for decreasing utilization of healthcare services, and penalizing them for excessive treatment. Hence, an HMO physician’s financial interest lies in providing less care, not more….[I]nducement to ration care is the very point of any HMO scheme [emphasis DrRich's] and rationing necessarily raises some risks while reducing others…Congress, which promoted the formation of HMOs for 27 years, may choose to restrict its approval to certain preferred forms, but the Judiciary would be acting contrary to congressional policy if it were to entertain an ERISA fiduciary claim portending wholesale attacks on existing HMOs solely because of their structure.
- in Pegram et al. v. Herdrich (98-1949), 530 U.S. 211 (2000)
So, dear readers, DrRich is not making this up. HMOs exist, and enjoy their congressional charter, specifically to ration our healthcare. That, the Supreme Court unanimously found, is their “very point.”
So, HMOs weren’t actually making their huge profits managing the healthcare of the sick. That, DrRich agrees, would have been morally reprehensible. Rather, the HMOs were making their huge profits for conducting the necessary but dirty job of covert rationing. For the 15 years or so that they did this job, effectively and without complaint, hiding the rationing just enough so that the rest of us could pretend to ignore it, DrRich believes they more than earned their money.
And now that the HMOs have run out their string, and are (in quiet desperation) turning to the Obama administration to help them with an acceptable exit strategy, one that might mollify their shareholders enough to keep them from tearing the HMO executives apart, let us show them a little consideration, in the way of acknowledging, an a historically accurate way, the service they have provided to our society.
DrRich just wanted to do his bit to set the record straight.
H/T to MedGadget who’s post introduced me to “bioactive sutures.” What a great idea by the Johns Hopkins biomedical engineering students!
……have demonstrated a practical way to embed a patient’s own adult stem cells in the surgical thread that doctors use to repair serious orthopedic injuries such as ruptured tendons. The goal, the students said, is to enhance healing and reduce the likelihood of re-injury without changing the surgical procedure itself.
The project team of 10 undergraduates focused on Achilles tendon injuries which require repair in approximately 46,000 people in the United States every year. The surgery may fail in as many as 20%. Recovery can take up to a year even with successful surgery. If this new suture speeds healing and lowers failure rates – what potential!
At the site of the injury, the stem cells are expected to reduce inflammation and release growth factor proteins that speed up the healing, enhancing the prospects for a full recovery and reducing the likelihood of re-injury. The team’s preliminary experiments in an animal model have yielded promising results, indicating that the stem cells attached to the sutures can survive the surgical process and retain the ability to turn into replacement tissue, such as tendon or cartilage……………
As envisioned by the company and the students, a doctor would withdraw bone marrow containing stem cells from a patient’s hip while the patient was under anesthesia. The stem cells would then be embedded in the novel suture through a quick and easily performed proprietary process. The surgeon would then stitch together the ruptured Achilles tendon or other injury in the conventional manner but using the sutures embedded with stem cells.