- The Washington Times - Monday, May 19, 2003

When HMOs emerged as the clear victor from the Clinton health-care reform debates of the 1990s, they had the promise of being a relatively cost-effective means by which consumers could gain access to solid health care plans. “Managed care,” as it was called, was all the rage in some circles; care for “the little guy trying to feed his family and so on. And yet, as in many things these days, let economics and old-fashioned greed enter an equation and the promise most things show tend to shrivel up like an old prune.

In just the span of a few years, the managed-care industry — while continuing to show double-digit profit margins that only boost the portfolios of investors and line the pockets of corporate executives — has masterfully shifted criticism about the burgeoning health care crisis from itself (in the late 1990s) to brand-name drug manufacturers. In so doing, the industry has profited richly, but it has done so while slashing benefit packages and denying claims for covered services. In other words, they have taken a cue on tactics from the kind of corporate folks currently under federal investigation.

While squeezing doctors for every penny they can avoid paying out and working to stick it to hospitals as well, major HMOs (health maintenance organizations) are now turning to schemes aimed at government agencies like the Federal Drug Administration to give themselves cover to uninsure million of patients. These ventures are devised under the auspices of giving consumers choice, but the fact is they are simply trying to curtail services and move as many people onto generic over-the-counter drugs as possible through deceptive lobbying and public-pressure campaigns.

Even if all this were somehow fair game, the very fact that in the same breath HMOs cut services they have notified employers of premium increases of 22 percent in 2003 is obscene. The effects are obvious. More cost to employer means more cost to employee, who now digs deeper to have HMOs pay out only 79.2 percent of premiums in claims as of 2000, according to the Wall Street Journal. This means health insurers’ overhead and profit totaled 20.8 percent of their total revenues. That, with 44 million people currently underinsured or without coverage, is unconscionable.

Seniors are especially threatened by forced over-the-counter switches since they are a population most likely to be on multiple medications at the same time, any number of which might counteract the use of an over-the-counter allergy drug or spur on a dangerous complication. At the same time that their health could be compromised, seniors are also more likely to be living on fixed incomes and relying on Medicaid and other supplemental insurance to cover the costs of prescription drugs. If their HMO is forcing them to pay out-of-pocket for allergy/asthma drugs, this may force seniors to make a gruesome choice — living with less allergy symptoms or not eating.

A most egregious example of HMO greed and lack of concern for patients is a company called Wellpoint Health Networks. Wellpoint is poised to become the nation’s third-largest health insurer and is expanding like ragweed from California to Missouri to Georgia. It is also being sued for racketeering by the California Medical Association. Among other acts of money-hustling and sheer disconnect from any commitment to patients, Wellpoint has petitioned the FDA on two occasions to move several anti-allergy medicines from prescription to over-the-counter status — one allergy drug having only been on the market for six months. This may sound good in the abstract to some, but what it ultimately does is force consumers to pay over-the-counter costs for drugs previously covered by their health plan, and prompt unnecessary and expensive visits to the doctor’s office. What it does for Wellpoint is, as The Washington Post noted, “save [them] money by not having to reimburse.”

Seniors beware.

James L. Martin is President of the 60 Plus Association, a grassroots senior-citizen advocacy group.

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