Note to Cowen: Anger Towards HMOs Is Often Rational

By way of Matt Yglesias, I came across this post by Tyler Cowen claiming that the dislike towards HMOs is due to "they [patients] could be told they can't get all the care they want." Cowen is wrong: the dislike towards HMOs and for-profit healthcare in general is often a reasonable conclusion after patients fail to receive the care that they need. Two personal examples come to mind.

One loyal reader, a few years ago, who had been on complete life support for eight days, was removed from the ICU days before any of the ICU doctors, nurses, or the primary care physician thought was appropriate. While I know a lot (more than some doctors) about what put said loyal reader in the hospital--bacterial sepsis--I am spectacularly unqualified to determine when said loyal reader should have left the ICU. However, three doctors familiar with his case, along with a couple of ICU nurses (who have to know their business, as they are the first response in what is, by definition, a critical condition) do know what they're talking about. It's not greedy or grasping to think that when medical professionals think something is a bad idea regarding a patient who, until the day before, was dying, one should listen to them. For all I know, these medical professionals were unaware of some study that demonstrated that the extra couple days in the ICU would have made no difference in outcome whatsoever. But still, it's not unreasonable to think that they...had a legitimate point of view, particularly since they stated this was a monetary, not medical decision.

The second example involves another loyal reader who is a juvenile diabetic. Said loyal reader (who I'll call "SLR" to save space) has had to fight numerous times over the type of insulin that will be covered as well as other diabetes-related medical supplies. Again, the issue from the insurer's perspective is cost, not medical efficacy. Because SLR is meticulous about recording SLR's multiple daily blood glucose readings (for over twenty years), we actually know what happens when these supplies change--and it's not good. In fact, SLR has such good control (i.e., is able to maintain blood sugar levels in the normal range), when SLR has been in the hospital, doctors defer to SLR when it comes to blood sugar levels. So when SLR says these cost-cutting methods are bad for SLR, this isn't well-informed speculation (as was the previous example), but observable (and observed) fact.

Keep in mind, this isn't a zit I'm talking about here: this is fucking blood sugar levels. When they soar too high, debilitating nausea ensues (I don't recommend the following--without going into the back story, I did this by accident--but it's like slamming rapid fire a couple of sugary sodas [the carbonation helps the sugar diffuse into your blood stream], except far worse and the juvenile diabetic's body can't self-equilibrate after a couple minutes). That's actually better than when blood sugar drops too low. Then, the person becomes irrational, then violently irrational as oxygen deprivation kicks in (your brain wants oxygen NOW!!!), followed by passing out and brain damage.

Suffice it to say, this is very serious shit. So my experience isn't 'wanting' everything because said loyal readers are spoiled brats, but expecting what is needed for basic health and not dying. Sure, there are morons and ninnies who want treatment they don't need, such as antibiotics for viral infections. But, for a lot of people, the dislike of HMOs is a rational response to lousy treatment by HMOs (and other private health insurers too).

The surreal subtext of all of this is that other countries provide healthcare with higher levels of satisfaction--this isn't rocket science, or inventing the wheel. And part of that satisfaction stems from good healthcare for less money. It can be done.

Or maybe Europeans are just smarter than we are.


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Even when you're not dealing with life-threatening issues, it can be fucking annoying. I'm waiting right now for X-ray results on my knee, knowing that they'll show nothing (there were no indications of bone damage). So why did I get them? Because the HMO won't approve an MRI without an X-ray first. I've got a good guess why--a few doctors at some time in the past prescribed MRIs for conditions that could have been accurately diagnosed with X-rays, and it cost the insurance company money. If they send 100 patients that were prescibed MRIs for X-rays, and 3 come back with enough information for a proper diagnosis, then the company only has to pay for 100 X-rays and 97 MRIs, which is cheaper than 100 MRIs. And the only problem is for me and the other 96 other people who get the expected negative X-ray back, who had to take time off of work to get the unneeded test, and spend more time limping around waiting for a diagnosis & treatment.

Yes, this makes me grumpy. :(

By Scott Simmons (not verified) on 06 Aug 2008 #permalink

As I posted on Mr. Yglesias' blog, the reason why people hate HMOs is that there is considerable evidence that medical decisions therein are being made by bean counting accountants, not medical professionals. In the real world, such accountants could be prosecuted for practicing medicine without a license. In the fantasy world of HMOs, they are immune from such a threat, all in the name of cost containment.

Agreed, SLC. I recently had a similar experience with WC - When my Doc initially ordered surgery to repair my Dequervain's Tenosynovitis (which had already been unsuccessfully treated with one package of corticosteroids, and three separate local steroid injections), the initial response from WC was a hearty "No." This from a case handler with no medical training.