• U.S.

Letters, Feb. 12, 1996

13 minute read
TIME

WHAT YOUR DOCTOR CAN’T TELL YOU

“No one disagrees that health-care costs need to be reined in, but the HMO approach of limiting care based on bottom-line profits is wrong.” STEVE N. GEORAS, M.D. Baltimore, Maryland

CONGRATULATIONS ON YOUR SPECIAL investigation of the state of U.S. health care [BUSINESS, Jan. 22]. It is ailing and failing rapidly, and health-maintenance organizations bear part of the responsibility for this condition. In a society where freedom of choice is a cornerstone, we surely must be able to find a better way to deliver effective health care to our people. As a person who is caught in the web of an HMO, I find the situation very scary. MARILOUISE BERDOW Ocean City, New Jersey

WE ARE LEAVING THE GOLDEN AGE OF medical treatment and entering the Dark Ages of managed care. MOLLIE FOTI Kailua, Hawaii

YOUR STORY OMITTED MANY RELEVANT points, but one stands out. TIME painted bone-marrow transplantation as a managed-care issue. It is not. It was and is an issue for everyone in health care. Our response to this issue, which we gave to you but which failed to make it into the article, is as follows: A panel of transplant physicians, drawn from California’s finest medical centers, created and continuously reviews guidelines for bone-marrow transplants. Since 1994, any case that does not meet criteria for approval and is appealed is automatically referred for outside review to the Medical Care Ombudsman Program, a national panel of independent transplant experts. Health Net has never reversed a decision of the MCOP. The panel has twice recommended against bone-marrow transplants. In the past three years, Health Net has approved 179 bone-marrow transplants, 55 of them for breast-cancer patients. To protect our medical groups from any adverse financial exposure for bone-marrow cases, Health Net has funded a special pool for transplants of all kinds. We are the only health plan to do so. Health Net has paid out more than $32 million from this pool in the past three years. These facts, if included, would have materially changed the impression of Health Net created by your unfortunate article. MICHAEL E. GALLAGHER Chairman, President and CEO Health Net Woodland Hills, California

I DON’T WANT MY HARD-EARNED HEALTH Net insurance money used for expensive treatment of terminally ill patients, and I hope I’ll feel the same way should I become terminally ill. HELEN HANSMA Goleat, California Via E-mail

IN YOUR STORY, HEALTH NET’S LYLE SWALlow defended the HMO’s rejection of a proposal to study ovarian cancer as a decision required by the Americans with Disabilities Act. Swallow argued that if Health Net researched ovarian cancer, this law would obligate it to allocate similar resources to other diseases. As one of the principal drafters of the ada and a practicing attorney with extensive experience in disability law, I can tell your readers that Swallow’s conclusion is flat wrong. Nothing in the ada requires a company that spends money to find a cure for one disease to expend resources to research other diseases. CAROLYN P. OSOLINIK Washington

WHY DON’T HMOS TAKE THEIR CUE FROM industry and replace those annoying doctors with robots? Then their nonmedical bureaucrats can make the diagnosis and decide on the treatment. And the HMOs could get on with their primary purpose–making money. MARCIA EVE KELLEY Richmond, Virginia

YEARS OF HEALTH-SERVICES RESEARCH indicate that the quality of care in HMOs is as good as–and in many cases better than–the care delivered in old-style, fee-for-service settings. Moreover, satisfaction surveys reveal that the 100 million Americans enrolled in HMOs, preferred-provider organizations and other managed-care plans are pleased with the treatment they receive. Through the years, these plans have developed integrated, coordinated care systems that ensure continuity and seamlessness for patients. These systems allow physicians to study the health of their patient population over time so that they can work together to improve the quality of care they provide. PATRICK G. HAYS President and CEO BlueCross BlueShield Association Chicago

HMOS WORK MARVELOUSLY UNTIL A PERson becomes sick. At that point, the HMO physicians are transformed from health-care providers into health-care deniers. I suspect that the percentage of patients who express satisfaction with an HMO is the same as the percentage who have not been sick or injured. JEREMY VOAS Phoenix, Arizona

A DOCTOR CAN ALWAYS SELL TO A DESPERate patient a procedure that offers scant hope and costs a great deal. In the future, though, we must sell not merely hope, but results. Fortunately, not all HMOs are using the patient’s money to support administrators as you described. ROLF NESSE, M.D. Coeur d’Alene, Idaho

HMOS GENERALLY COMPARE VERY FAVORably in studies of patient outcomes to other patient populations. The true medical horror stories you should be covering are the ones that result under traditional fee-for-service medicine when no one is managing the care. JO FRKOVICH Dana Point, California

DOCTORS WHO THOUGHT THEY WERE God were much easier to work with than these new doctors of greed. The former usually came equipped with a soul. The latter appear to have none. VERDA H. BIALAC Omaha, Nebraska

HMOS HAVE BEEN BOTH GOOD AND BAD for health care in the U.S. We have learned about waste and limited resources, and that more is not always better. But HMOs erode the doctor-patient relationship. Society wants physicians to control costs. It also wants them to be advocates for health. Most doctors want to be on the side of the patient. However, third-party payers (not just HMOs) can be intimidating. Money is powerful. But most doctors do their best for the patient, or at least what seems to be the best. DAVID S. SMITH, M.D. Milwaukee, Wisconsin Via E-mail

TODAY “PRACTICE PROFILES” ARE BEING formed on how much it costs for a physician to treat each illness. This profile would be quite important in my individual “credentialing,” in determining whether I could participate in an insurance plan or be on a certain hospital staff. Quite a change from when credentials were determined by training and ability. The winners in this scheme: big business, the insurance companies, the hospitals and the lawyers. The losers: doctors and their patients. PAUL M. PAVLOV, M.D. Ocean Springs, Mississippi

A SORROWFUL FAREWELL

MANY OF THE ARTICLES ASSESSING THE career of Francois Mitterrand [CHRONICLES, Jan. 22] failed to emphasize one of the most telling pieces of evidence about his character, his use of the office of the presidency of France. Mitterrand attacked Charles de Gaulle’s Fifth Republic as a “permanent coup d’etat” because of the excessive power wielded by De Gaulle when he was President. When Valery Giscard d’Estaing took the job, Mitterrand referred to that President’s concentration of power. Mitterrand repeatedly called for a revision of the French constitution so that it would limit presidential powers, shorten the President’s term and increase the powers and independence of Parliament and the judiciary. Of course, this was conveniently put aside when Mitterrand assumed the office.

He concentrated power as much as any of his predecessors or more, as is illustrated by his building program. Only during his second term did he start talking again about revising the constitution. One explanation can be found in Richard Nixon’s memoir In the Arena. Commenting on the powers of DeGaulle’s presidency, Mitterrand told Nixon, “We didn’t like it when he was in, but we like it much better now that we are in.” PETER BARTL Aachen, Germany Via E-mail

HOW REFRESHING TO READ YOUR WELL-balanced article about our late President Mitterrand after so many fiery and laudatory reports about him in the French press. Thank God for TIME. Your magazine has re-established the truth by restoring objectivity. JOSIANE VOISIN-SANTAM Jurancon, France

WHY ALL THIS GLORY FOR MITTERRAND, who was a sad, severe and selfish President? In his 14 years in office, he made the rich poor and the poor miserable. He worked more for his own image than for the French people. GEORGE DENIKIAN Riyadh

FRANCOIS MITTERRAND WAS CULTIVATED, intelligent and deeply human. An era is ending, but his ideas remain. He was the man responsible for the ambitious building program of the grands projets and other remarkable achievements. He abolished the death penalty and, like his wife Danielle, was an advocate of human rights. I will never forget him. CAROLE NAGAU Ivry-sur-Seine, France

MITTERRAND WAS THE TYPE OF STATESman that I admire. He was clever, crafty, cunning, ambiguous, honest enough and likable. As is typical of the French, however, he was no visionary. He should have foreseen the possible collapse of the Soviet Union. But many countries could use a statesman like Mitterrand in order to further world peace and justice. JAMES P. MACMANUS Cranbourne, Australia

HATEMONGERS ON THE NET

RE YOUR REPORT ON THE EXPANDING presence of organized racist and bigoted groups on the Internet [MEDIA, Jan. 22]: we will never achieve the ideal society that most of us are striving for by brushing the views of a minority, even a hateful one, under the carpet, whether that action be in cyberspace or in the mainstream media. Addressing, not ignoring, racism is the answer. STRUAN MALCOLM Manchester, England

EAVESDROPPING BY BOSSES

I AM CONTINUALLY AMAZED AT THE STUNning similarity between children’s antics and government policymakers’ actions. A prime example is the new Illinois law that allows employers to eavesdrop on their workers’ phone calls [BUSINESS, Jan. 22]. The image this brings to mind is myself at about eight years of age listening on the extension to a phone call between my brother and his girlfriend. I was ashamed of my actions then, as employers should be of theirs now. They should respect their workers’ basic human right to privacy as well as their freedom of thought and speech. KERRY J. WILLIS Whitecourt, Alberta

THAT BANANA REPUBLICAN

AFTER READING YOUR REPORT ON CARL Lindner, the Chiquita Brands banana tycoon who showers money on members of Congress to get favorable free-market trade for bananas [BUSINESS, Jan. 22], I have concluded that the U.S. is not a democracy. In a democracy the people rule through their elected representatives: one man, one vote. Not so in the U.S. (or in any number of other countries). The basic idea is more like: $10,000, one vote! The electorate chooses certain people. These then go on to receive hundreds of thousands of dollars for doing what certain companies and associations want. That’s not democracy. Politicians should not be influenced by special-interest groups or individual executives in this way. Not only is it unfair to those people who can’t “afford” a member of Congress; it’s also unfair to those who really should have the last say in it all–the voters. STEFAN MOLLER Lindome, Sweden

CEASE-FIRE IN THE BALKANS

MORE ARMS AND TRAINING FOR THE Bosnian Muslims [WORLD, Jan. 15] increase the likelihood that war will resume once NATO troops depart. The nominally federated Muslims and Croats of Bosnia may be tempted to resolve their seemingly irreconcilable differences at the expense of the Bosnian Serbs. The spoils from a joint military campaign to expel the Bosnian Serb nation would be allocated mainly to a Muslim entity, which would then accept its lot as a satellite of Greater Croatia. There is a precedent for what amounts to “benign ethnic cleansing.” Croatia, with Washington’s blessing, invaded the U.N.-protected Krajina region in August last year and murderously drove the Krajina Serbs from their ancestral lands. The Dayton accord is in essence a temporary cease-fire. It can be made permanent, provided the international community firmly declares that the partition line between the Bosnian Serb Republic and the Muslim-Croat Federation will be treated as an international border in case of armed incursions. YUGO KOVACH Twickenham, England

AS A BOSNIAN SERB LIVING IN CANADA, I resent your depiction of Radovan Karadzic as “the Bosnian Serbs’ fuhrer” in your report “Now It’s Serb Against Serb” [WORLD, Jan. 22]. Blame should be placed on Alija Izetbegovic and Franjo Tudjman as well. They have done the same amount of damage to the people of the former Yugoslavia as has Karadzic. Even though I personally don’t like Karadzic, I wouldn’t put him in the same class as Hitler. Any personal vendetta against Serbian politicians is deplorable. ILIJA TANOVIC Windsor, Ontario Via E-mail

BUFFOONERY AND THE BUDGET

DECADES OF DEBATE OVER HOW TO reduce the U.S. deficit have produced nothing but hot air and ballooning debt [NATION, Jan. 22]. Outside observers might conclude that it is the quintessence of social buffoonery for Americans to sleep politely for decades, filibustered into tacit submission by a representative body that fully intends to give it little else but more of the same. RICHARD T. CROWELL Miami

SOME COMPROMISES NEED TO BE MADE as we progress toward a balanced budget. Perhaps stopping the paychecks for Congress and the President would be the best tactic. WILLIAM G. SMITH Fallbrook, California

CONCERN OVER CHINESE ORPHANS

THE TRUTH ABOUT CHINA’S ORPHANAGES may lie somewhere between Jill Smolowe’s politically sensitive appraisal [VIEWPOINT, Jan. 22] and Human Rights Watch/Asia’s savage expose of “a secret world of starvation, disease and unnatural death.” What is clear, however, and a valid concern to all caring people is that thousands of Chinese children are condemned to minimum care, inadequate nutrition and meager love. LAUREL OSBORN Salt Lake City, Utah

IT WOULD CERTAINLY BE REGRETTABLE, as Smolowe observed, if the Chinese government reacted to the publication of our report on the appalling conditions in Chinese orphanages by shutting off the flow of adoptions. But it is more regrettable that Smolowe chose to denigrate our research. Given that the vast majority of Chinese orphans have little prospect of overseas adoption, their only hope of survival is for the state to act immediately to bring down orphanage death rates. Medical records from the Shanghai Children’s Welfare Institute, long held up as China’s model orphanage, show that as recently as the early 1990s the majority of abandoned children who arrived there were dying unnecessarily, often from a policy of deliberate starvation. Perhaps a more balanced assessment by TIME would have focused less on the impressions of one adoptive parent and more on the documentary evidence of deliberate, fatal neglect presented in our report. KENNETH ROTH, Executive Director Human Rights Watch New York City

MY HUSBAND AND I ADOPTED OUR SEVEN-month-old daughter in 1993. During the three weeks we spent in China, we visited our daughter’s orphanage in Yangzhou three times. Like Smolowe, we found a facility that was neither modern nor deplorable. While spartan at best, it was clean and well kept, and the children were obviously well fed and loved. We saw none of the abuses alleged by Human Rights Watch/Asia. Rather, we saw orphanage personnel who truly cared about the children. While abuse and neglect cannot be tolerated in any form, the agency’s report threatens to hurt the very people it aims to help–the Chinese children. DENISE PANYIK-DALE Belleville, Illinois Via E-mail

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