"WE SEE PEOPLE AS NUMBERS, NOT PATIENTS. IT'S EASIER TO MAKE A DECISION. JUST LIKE FORD, WE'RE A MASS-PRODUCTION MEDICAL ASSEMBLY LINE, AND THERE IS NO ROOM FOR THE HUMAN EQUATION IN OUR BOTTOM LINE. PROFITS ARE KING."

Those are the words of a leading HMO executive, as quoted in the 6/18/97 edition of the Wall Street Journal.

"Health maintenance organizations" (HMOs) and the managed-care industry are NOT your friends. Sure, you've seen all the warm 'n' fuzzy TV commercials and print advertisements -- the happy celebrities surrounded by puppies and/or babies, telling you how wonderful your health care will be if you'll just choose this or that HMO. Well, here's a cold hard slap in the face, folks: THE HMOs DON"T GIVE A SHIT ABOUT YOUR HEALTH.

As evidenced by our friend who was a little too honest with the Journal, HMOs are interested in one thing, and one thing only: making money. That seems reasonable enough -- they're businesses, after all. But like all businesses, they can only make a profit if they take in more money than they spend. To you, Joe Public, that basically means that if you pay $100 for health insurance, the HMO needs to spend less than $100 in health care for you, in order for them to make a profit.

But you PAID for what you were told is full access to health care, didn't you? So when you slip and sprain your ankle, you should be able to go to the emergency room, receive prompt and appropriate treatment in the judgment of qualified medical professionals, and get any and all required follow-up care -- maybe you slipped because of an underlying problem with your balance that could be caused by inner-ear disease, or even a brain tumor. Maybe your sprain caused joint damage that should be evaluated by an orthopaedic specialist. Maybe you slipped because you have a drinking problem that should be handled by addiction and rehabilitation specialists. So you'll receive all those appropriate referrals and follow-up care, won't you?

NO! You most certainly will NOT! First of all, you'll have to call your primary- care doctor for permission to go to the emergency room -- even though you're in severe pain, and you know damn well you need immediate medical attention. Better hope you can get through to him or her -- because of many doctors' practices being bought out by HMOs, often you can only reach the answering service, which has specific instructions NOT to bother the doctor except for life-threatening emergencies. So you'll spend the night in pain, waiting for the doc to pick up your message. When he finally does, and you get permission to visit the E.R., you'll likely wait in a long line. HMOs have closed so many unprofitable hospitals that those still operating are hugely overburdened -- a simple case of too many people in need of an increasingly-scarce service.

After waiting more hours, still in pain, you'll finally be seen by a doctor. Probably a doctor who's been continuously awake for up to 36 hours -- that's right, 36 hours. A disoriented, groggy doctor desperately in need of sleep, who is about to make a medical decision that could have permanent, serious consequences. After all, do you know whether you just have a sprain? Maybe you've broken a bone, or seriously damaged the joint -- you don't know; that's why you're seeing a doctor. But the hospital is under strict orders from the HMO to keep costs down and keep profits up -- so the "doctor" you're seeing is an overworked, sleep-deprived intern who works up to 100 hours a week. After a simple examination, he'll order an X-ray of your ankle (if you're lucky), and after another long wait, you'll be told you sprained your ankle. Whoever is handy -- an EMT worker, a nurse, even an orderly -- will supply you with a pair of crutches and show you how to use them. You'll be given a prescription for pain medication -- usually inadequate to really deal with the pain you're experiencing, like a prescription-level dose of ibuprofen or acetominophen (when you really should receive a a small prescription for more-expensive painkillers) -- and be sent home.

Maybe the doctor remembered to ask you how you sprained your ankle, and you answered that you twisted it as you fell. Twist falls can cause extensive injuries to the joint which can only be determined by an MRI scan -- but you didn't get an MRI. That's an expensive test, and the HMO does NOT want expensive tests done -- and if you're lame for life, tough luck for you. The HMO doesn't care -- they made money by limiting your access to health care, and that's all they care about -- it's the core of their business philosophy.

A few years ago, Columbia HCA -- a regional HMO -- decided to move up to the "big time." In an aggressive plan developed by its executives, Columbia went on a buying spree. The HMO bought dozens of hospitals, physician's practices, diagnostic laboratories, outpatient clinics, and became a gigantic health-care behemoth. Wall Street stock analysts were impressed. So were the managers of many corporate pension funds all across the country, who invested heavily in Columbia stock. The staffs of their hospitals were not impressed, however -- many charged that Columbia was insisting on a yearly profit goal that was impossible to reach without compromising patient care. Columbia denied that, and claimed it did nothing to endanger patient care.

Then the blow fell: early in 1997, new reports revealed that Columbia HCA and several of its top executives were under investigation for fraud. In an effort to shore up profits, the HMO allegedly billed Medicare and Medicaid for procedures and tests that were never performed. Still, no one seemed to be upset by this except for the government, and the executives accused. Then in October, true disaster struck. The company's reported earnings were so far below estimates that Columbia stock plummeted almost fifty percent in value in a single day! The cat was out of the bag -- Columbia's strategy was unworkable in the long term, as doctors and nurses had been saying all along. It was just an elaborate version of a "Ponzi" or pyramid scheme, and the pyramid had finally come crashing down. "So what," you ask, "Who got hurt except some fat-cat stock market players?"

YOU got hurt -- if you were a Columbia hospital patient. YOU got hurt, if you worked at any of the thousands of companies with pension funds invested in Columbia stock. YOU got hurt, by alleged theft of your tax dollars from the two programs that take care of the sickest and poorest Americans -- theft by wealthy, intelligent, well-educated executives, not by the poor folks who were supposed to get health-care with that money. YOU got hurt, if you were one of the many workers laid off from Columbia's takeovers in order to increase profits. Let me just shorten the list a little: if you paid any U.S. Federal income taxes in 1995, 1996 or 1997, YOU got hurt!!!

Still not convinced? Medical Economics, a journal that reports on the HMO industry, reported on July 14, 1997 about a scheme by Oxford Health Plans to increase profits. Oxford wants to cut out primary-care physicians (!) and replace them with nurses, called "nurse practitioners." In other words, Oxford patients won't be able to see a real doctor unless a nurse refers them! M.D.'s and D.O.'s have far more training and expertise than nurses. And it's obvious that no one should be practicing medicine without the necessary knowledge (and license!) to do so -- but Oxford does't give a damn. Nurses are cheaper than doctors, which increases their profits. Too bad for patients who are going to get substandard care. There are no studies to show whether it's safe for nurses to act as primary-care health providers. Oxford certainly didn't do any such study -- first of all, it would have cost them money to conduct a study; secondly, they probably guessed that such a study would show it was NOT safe for nurses to act as primary care providers, and that would have burst their balloon on this new scheme to make more money while providing less care.

So -- what happens when the heartless, thieving HMO execs get caught ripping off Medicare and denying care to people who need it? They reap HUGE rewards, that's what happens! Sure, the chief executive officer of Columbia HCA was forced to leave after the company hit the skids. But did he get booted out penniless and headed for jail? Hahahahahahaaa!!! Stop, you're killing me! No, Columbia's CEO sailed out the door to the tune of a $15 million "severance package!" That's right, folks: the man runs the company into the ground, put thousands of people out of work, set policies that denied care to people who deserved -- and had already paid for -- that care, and caused major damage to retirement-investment portfolios across the nation. And for all those wrongs, he was rewarded with a fifteen-million-dollar bonus.

Fifteen million dollars for getting fired. Kind of a sweet deal, huh? Of course, that fifteen million was supposed to pay for Grandpa's bypass surgery, and Johnny's knee- replacement, and Donna's breast cancer therapy, and Uncle Joe's prostate biopsy, and Nana's hip operation -- multiplied by thousands of families across America. Do you think that makes Columbia's ex-CEO upset? Oh sure! -- he's sobbing all the way to the bank. In his custom-tailored Hugo Boss suit, sitting in the back of his chauffeured limousine, he no doubt whips out a hand-hemstitched monogrammed Irish-linen hanky to wipe away a tear of regret, before taking another sip from his Baccarat crystal tumbler of single-malt Scotch.

The HMO execs just love telling us that they want to make health care more affordable, more available, easier to access for us consumers. Want an example of their real agenda? In May 1998, Keystone Mercy Health Plan of Pennsylvania sent all of its subscribers a "formulary." A formulary is a list of drugs approved by the HMO for its subscribers! And a quick perusal of KMHP's formulary shows that the drugs listed are the cheapest in their respective classes. Here's how it works: each KMHP client is supposed to tote this formular along to the doctor's office. If the doctor needs to prescribe a drug, he/she must browse through the very limited choices in the formulary, to see if that drug is approved by the HMO. If that drug isn't listed, the doctor then has to check and see if there's a similar drug on the formulary. If there isn't -- well, KMHP has very kindly set up a process for the drug to be approved for that patient. A process so complicated, so onerous, so time-consuming, that it's obviously designed to discourage doctors from prescribing any drug not on the formulary!

Also in May 1998, KMHP sent out an "apology" to subscribers, informing them that prescriptions could no longer be filled at CVS or Eckerd pharmacies -- two of Pennsylvania's largest pharmacy chains. The HMO's letter hinted that CVS had been unreasonable and unwilling to compromise with KMHP. The truth? KMHP had offered drug-reimbursement fees to CVS and Eckerd that were so low, the pharmacy chains would have lost money on most of the prescriptions they filled!

And just to make sure all subscribers -- and their doctors -- got the point, KMHP's formulary prominently encourages doctors to prescribe generic drugs, rather than more- expensive brand-name drugs.

How is this making health care more available, accessible, and affordable? Subscribers now have to travel to a different pharmacy, even though they may live near to a CVS or Eckerd pharmacy. Subscribers must hope that their condition is treatable with the cut-rate, cheap drugs listed in the HMO's formulary. The HMO's MUST be regulated out of business, before their profit-gouging tactics and policies contribute to the death of more consumers!

In June of 1998, we saw news reports from California that demonstrated the cruelty of dumping Medicaid patients into sate-run HMOs. Seven women, at least one of whom has filed a lawsuit, were denied anaethesia during childbirth -- probably one of the most painful human experiences. The women claim that a hospital anaesthesiologist demanded cash payment on-the-spot to provide pain relief, because the state HMO's reimbursement was "...too low." One woman offered the anesthesiologist both a credit card and a Western Union confirmation number to guarantee the $400 extra fee that was demanded -- but the anaesthesiologist refused, insisting on cash!

Whose fault is it that those women suffered excruciating, and needless pain? The hospital's? After all, a hospital has to close its doors if it doesn't make enough money to cover its costs. Was it the anaesthesiologist's fault? How can we expect a doctor to pay hundreds of thousands of dollars annually for medical malpractice insurance, yet insist that he or she provide services for inadequate reimbursement? No -- the fault here lies with the HMO! State-run or not, the HMO should provide a reimbursement that is reasonably in-keeping with the prevailing average cost of a medical service or procedure. Second-rate reimbursement sends the obvious message that Medicaid HMO patients are second-class citizens.

Please, folks, do NOT fall for the "big lie" the HMOs are telling us! HMOs are NOT about saving money, or providing greater access to health care, or keeping the costs of health-care down. HMOs are about one thing, and one thing only: MAKING BIG MONEY FOR THE HMO!!!

These companies must be controlled and regulated to the point that they are literally driven out of business. That sounds extreme -- but there is no other way to deal with the rapacious, unabashed greed. Medicine-for-profit is immoral. There can be no other conclusion. One cannot morally profit from another human being's pain and suffering, actual or potential -- and that is precisely what HMOs do. Some argue that doctors and hospitals also profit from human pain and suffering. NOT TRUE! When you pay a doctor or a hospital, you're paying for a service rendered directly to you -- just like paying a plumber's bill or a lawyer's bill. But when you pay your HMO bill, you are giving a part of that money to a company which is not providing any medical service to you -- in fact, the HMO skims a percentage of your payment as its "take" right off the top! If you don't get sick, you still pay your HMO bill -- and they keep the money!

Call and/or write to your Congressman. Tell your doctor. Complain to your local hospital. Corner your Senator on his/her next campaign visit. Bitch to your pharmacist. Write to your local newspaper's Letters To The Editor. Write to the American Medical Association. Protest to your dentist. But, do SOMETHING to stop the rampant steamroller of the HMOs before you get steamrolled by their uncaring, profit-hungry tactics -- before your wife or daughter or husband or son or brother or sister or grandmother or grandfather DIES, needlessly, because of HMO tactics and profit margins!