essay on Against Health Maintenance Organizations

Health Maintenance Organizations

Throughout history, America has always strived for freedom and quality of life. Wars were fought and people died to preserve these possessions. We are now in a time where we may see these ideals crumble like dust in the wind.

Health Maintenance Organizations and HMOs are currently depriving millions of people of quality health care and freedom of choice. This is occurring because people who are enrolled in HMO’s are unable to choose the doctor that they want. Also, patients lose the quality of care because HMO’s interfere with the healthcare providers’ decisions.

The Health Maintenance Organization has been proven to “sometimes interfere with physicians’ exercise of sound medical judgment and avoid covering necessary medical care, causing members to either pay out of their own pockets or go without” (Schlossman). This means that the insurance company does not really care about you. T

he insurance company only cares about how much money it has to spend on you as a person and if you need a type of special care that cost money either you can pay for it yourself or just go without the care that is needed.

This interference often compromises the patient’s ability to have freedom of choice in selecting a provider and to get the best quality for their health care needs. This freedom of choice is the ability to choose the doctor that you want as a doctor. Yet instead HMOs pick the doctor for you.

All over the United States, HMO’s have denied patients the medical care that they need. In Charlotte, North Carolina, for example, a boy named Ethan Bedrick was born with cerebral palsy. His doctors said that in order for him to be able to ever walk, he would need extensive therapy. Yet according to HMO policy, patients are only allowed a maximum of fifteen therapy sessions per year; therefore, his health plan said “NO.” The HMO said no when a little boy said please help.

This proves why HMO’s frequently deprive patients of the optimum quality of life. This little boy’s future of being able to walk was crushed by an insurance company that was so money-grubbing and greedy that it could not stretch the rule for this case. Since the boy’s therapy is not being paid for the HMOs get a bonus in their paycheck.

They took the money that was supposed to go to the therapy and put it into their pockets. An epidemic has occurred in most senior citizens’ lives. Since January 1, 1999, 440,000 senior citizens have lost their HMO privileges. In essence, HMO’s decided to arbitrarily eliminate the senior citizen plan. The sad reality is that many members who subscribed to these particular HMO’s for their senior citizen’s package are out of luck and without medical coverage.

Many people over the age of 65 who once had, HMO benefits are now scrambling to find new insurance. There are people like Allen Martin from New York, who is over the age of 65. Due to severe disease, his kidneys do not work. As a result, he needs dialysis, (which is when the waste material is flushed out of the body) three times a week.

This process is extremely expensive costing hundreds of dollars each time and what was once paid for by the HMO, but now he has to find some way to pay for it on his own. In many cases, doctors are unable to tell a patient the limitations of their particular HMO and how it interferes with the ability to provide good medicine.

This is called the “gag rule”. These gag rules do not allow the doctors to say anything bad or against HMO’s. Also, the rules restrain doctors from telling the patient certain things that HMO’s do not pay for such as special procedures that might benefit the patient’s condition. Doctors who work with HMO’s have to sign a contract. This contract states that a doctor is unable to tell patients certain things. Yet in frequent cases, doctors have felt limited by their contract with HMO’s.

This is because they want to tell patients important facts, but are unable to because of the contract. If the doctors break this agreement, they stand to lose their contract with the HMO. The Health Maintenance Organization created a situation where patients have lost the ability to select the doctor of their choice.

In addition, many plans have something called a “Gatekeeper”. The gatekeeper is a businessman who probably does not know anything about medicine or what to do in a critical medical situation and makes his decisions solely on how much is it going to cost. The Gatekeeper tells you that you must see a Primary Physician before you can see a Specialist. This is just one extra step that the patient must take to get care.

This process normally takes an extended amount of time resulting in interference in the quality of care. Freedom of choice is a fundamental aspect of being an American. This is being eliminated by HMO’s whose only concern is making money.

These companies seem to have little interest in the quality of care and the health of the people of this country. Finally, the health care system in this country is being denied the opportunity to provide a treatment which is based on the decisions of trained professionals, but rather is being dictated by money managers who profit from preventing care from being given. The United States has been built upon the principles of choice and quality. We must not allow these basic concepts to disappear.