Saturday, January 14, 2012

Get Over It!! 

There is a cartoon called Non Sequitur that appears regularly on newspaper comic pages. 

The one I saw in the January 9 edition of the Omaha World Herald showed six grim reapers, complete with scythes, sitting around a table with stacks of paper in front of them.  The cartoon was labeled “The HMO Review Board” and there was a bulletin board on the wall with the words “Days without accidentally approving a claim” and topped by the number 12795. 

 (In the unlikely event someone doesn’t know what an HMO is, it is an organization that is obligated to provide all the services a person needs in return for a predetermined, prepaid, fixed monthly payment.)  The cartoon reflected the common caricature of HMO’s as money grubbers that grow their profits by refusing to pay for the medical care their subscribers need. 

HMO’s do engage in something called utilization management and undoubtedly there are unscrupulous operators who abuse the system.  But that does not obviate the need for somebody to monitor providers that are known to provide unnecessary services and to exercise judgment in deciding whether the benefits of an expensive test or treatment bear a reasonable relationship to the cost involved. 

Given that we can now see the day when health care represents 20 per cent of the economy and is a threat to economic stability, we can no longer afford the traditional notion that when it comes to health care, money doesn’t matter. 

So for those who get upset at the idea that cost considerations are playing a part in medical decisions, I have this advice:  get over it.

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