Letters To The Editors

When cooperation is collusion

As an HMO administrator and former practicing physician, I have two comments on Paul Winick's article, "How I stopped an HMO from cutting our capitation rate" [August 20]. Dr. Winick was a wise negotiator. Unlike many doctors who simply blow off steam when engaging an HMO, he made sure he had all his facts straight first. Then he analyzed the HMO's position and crafted his response in terms that would appeal to them.

On the other hand, Dr. Winick was playing with fire when he discussed capitation rates with his colleagues. Although his inquiries were legitimate, they easily could have progressed to a violation of the federal antitrust laws that prohibit price fixing. Your readers should be aware of the dangers of discussing fees with fellow physicians.

It may be unfair that doctors cannot band together to negotiate contracts with HMOs. Perhaps that will change some day. But for now, there are no federal antitrust exemptions. One ignores the law at great peril.

Steve Jacobs, MD
Modesto, CAsejacobs@alumni.indiana.edu

Lessons of managed care are lost on patients

I agree that the managed care experience has taught doctors to be more cost-conscious ["Memo From the Editor: Doctors have learned," Aug. 20]. Unfortunately, it has had the opposite effect on patients. They are more demanding than ever, expecting the best of everything, regardless of the price.

A patient paying cash is grateful to hear about a generic alternative to a pricey medication. But a patient with prescription coverage opts for the direct-to-consumer-advertised brand: "It's okay. I pay only $5 with my plan."

Similarly, the price of care escalates as plans with low and zero copays extend an open invitation to visit the doctor for trivial reasons. Under managed care, it often costs the common cold sufferer no more to see a physician for a decongestant prescription than to go to the drugstore and buy something over the counter.

Patients have to learn that they, too, have a responsibility for containing health care costs. I doubt that many of them even realize how the cost of their care affects the premiums they pay.

Steven Gitler, DO
Cherry Hill, NJSgitler@aol.com

HMOs: Hard to live with, impossible to live without

As a solo family physician living and working in one of the poorer rural counties of New York—and one who (begrudgingly) accepts HMO insurance—I'd like to comment about doctors who have opted out of, or never joined, managed care plans. I have difficulty accepting the black-and-white brush with which these physicians paint the world.

Not only do I doubt that I can earn a living without managed care, I'm even more disturbed by what would happen to my insured patients if I turned my back on HMOs. These people need my help, but can't afford to pay me out of pocket. Although I am fed up with the numerous problems associated with managed care, will my soul really be "free" if I turn away the couple I'm counseling, or the impoverished grandmother who is raising her grandchildren because their parents can't or won't?

I have struggled with these issues, at times enraged over the actions of insurance companies. Ultimately, physicians and patients must unite so that both populations are better served by HMOs.

Wayne S. Strouse, MDPenn Yan, NY

Edited by Liz O'Brien,
Associate Editor

Address correspondence to Letters Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to meletters@medec.com, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication. Also, let us know if you don't want your e-mail address printed with your letter.

Liz O'Brien. Letters to the Editors.

Medical Economics

2001;19:13.