Sunday, July 01, 2001

Bad medicine

Dying for a doctor

        In my nightmares, I go to see my doctor and Ted Kennedy walks into the exam room wearing a lab coat. I check the diploma on the wall: “Doctor of Spendology” it says. “M.D. — Mendacious Demagogue.”

        He waves a toy stethoscope in my direction and mumbles, “You need a wallet-ectomy followed by copious bleeding.”

        I demand a second opinion — and he brings in Hillary Clinton and a swarm of trial lawyers who say it will cost me an arm and a leg. Yes, literally.

        Welcome to Marx Brothers Hospital, where the quack medical staff has a new cure for health care pains — the Patients' Bill of Rights.

        The main ingredient is distilled extract of litigation. It works on the principle that there is no medical problem that cannot be made more painful and costly by an injection of lawyers. Got an ache? Sue your HMO. Still hurting? Sue your boss, too.

        And if your employer drops health care coverage to avoid lawsuits, Dr. Ted and Nurse Hillary are hoping you will get sick and desperate enough to beg for brain surgery with a butter knife: nationalized health care.

        Many employers are already thinking of dumping health care, according to Dr. Derek van Amerongen, medical director for Humana/ChoiceCare, our region's biggest HMO.

        “They wonder, "Why are we spending billions on health care? That's not our business.'”

        So corporations tighten the screws on HMOs, and HMOs cinch the bolts on hospitals and doctors.

        The bread-and-water diet doesn't apply to everyone in health care. Bill McGuire, CEO of United Health Group, parent of United Health Care in Cincinnati, was paid $54 million last year ($1.7 million salary, $3 million bonus and about $48 million in stock options).

        But Cincinnati leads in cheap reimbursements — and nursing shortages and doctors leaving for Indianapolis, Columbus or other cities that raise their salaries 50 percent or more. Many new doctors won't even consider Cincinnati.

        Lynn Olman, president of the Greater Cincinnati Health Council, tells a good news/bad news anecdote about recruiting. “The good news was that we finally found two new radiologists. The bad news is that we wouldn't even be looking at these people a couple of years ago.”

        “It's not like we have a crisis brewing in Cincinnati,” she said. “We are in one.”

        And stingy reimbursements have a risky side effect: excess surgery.

        Like the guy with a hammer who sees every problem as a nail, some doctors with scalpels see every patient as a surgery waiting to happen. To compensate for shrinking reimbursements, a few have adopted the high-volume Walmart approach, doing surgeries at two or three times the national average.

        And the HMOs know it.

        “Yes, it may very well be that there are physicians doing procedures that are not medically justified,” said Dr. van Amerongen of ChoiceCare.

        So where's the manage in managed care?

        “We have backed off very dramatically on the things we pre-authorize and monitor,” he said, because that's what the public wants: unlimited care at a limited price.

        “It's no secret there has been a tremendous backlash. In national polls, managed care companies are next to the bottom, a step above tobacco companies,” Dr. van Amerongen said. “Thank God for the tobacco companies.”

        I think lawyers used to say the same thing. Now they're thanking Ted Kennedy for the right to sue HMOs that fail to provide free prescriptions and the best medical care in the world for a $10 co-pay.

        One of these days, a lot of aging baby boomers could be dying for a nurse or a good doctor. Dr. Ted and Nurse Hillary won't be much help.
        Contact Enquirer Associate Editor Peter Bronson at 768-8301; fax: 768-8610; e-mail: Cincinnati.Com keyword: Bronson.


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