Two major "quality assurance" agencies, the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance, have been organized to oversee the and regulate the health care industry.
"Why, what a wonderful idea," you might be thinking, "those HMO's truly need someone to keep an eye on them". As usual, I could not agree with you fine folks more. So why am I even bringing this up? Because both organizations were founded and funded by the same HMO's they presumably are regulating. Still feel safer? I thought not.
Ladies and Gents, the problem with HMO's is most assuredly not quality control. The problem is access to quality medical care and the ability of your personal physician to perform the requisite tests, procedures and referrals without the interference of bean-counters hundreds of miles away whose sole concern is the company's bottom line and not your life span. The ludicrous organizations that the healthcare industry have initiated are one hundred percent only to distract you from this fact. The reality is that HMO's first and foremost responsibility is to their Board of Directors and stockholders. Period!
What are the real issues that the healthcare industry are trying to distract your attention from?
First, consider that your physician is rewarded for minimizing the treatment you receive. These financial incentives are a major part of the contracts the providers must sign in order to be covered by the company. How can you be certain that you are receiving the best medical care available? Actually, you can't, no matter how caring your physician is. He or she must still find a way to earn a living and may, even unconsciously, give less than perfect care. Do you honestly believe that these healthcare organizations want you to think about that?
Next, here is scenario for you to consider. Your doctor believes that a particular course of treatment is necessary, or that emergency care is called for, and the managed care provider disagrees which, as a result, causes your death or permanent disability. Are you aware that the doctor can be held liable but not your managed care organization? Why? Because the guidelines that these very same organizations have written make the level of proof necessary to prove liability nearly impossible to reach against the company but relatively easy against the physician. Now that seems fair, doesn't it? The doctor says you need a certain treatment, the HMO says no and you can only reasonably sue the doctor. What a country!
How about if a psychiatrist believes a patient is a danger to himself or others but the HMO, again, disagrees? The psychiatrist has a moral, ethical and legal duty to hospitalize this individual but cannot because the insurer refuses to pay the necessary fees. Again, guess who is responsible should this patient commit acts of violence? You got it...the doctor. Again, sounds more than reasonable, huh?
These are only a few of the many, many issues that the HMO's genuinely do not want you to either know about or, when you acquire the information, to think about. Once you began to think about how poorly you are truly covered by your HMO you might begin to want to change this ignoble system. (When people learned about the nefarious "gag clauses", state-wide propositions were voted on and the clauses were deemed illegal.)
Consequently, the managed care companies developed the objective that if they could start the above mentioned "quality assurance" groups then you would feel as if someone were policing the HMO's for you. As you should have figured out by now, they aren't, in any way, whatsoever! It's a sham and a diversion and a invention. Business and government have learned the valuable lesson that all they have to do is make the appearance of an effort to regulate those responsible for your safety and health and you will follow along like the good sheep they believe you to be.
Well, hopefully, we won't be heard bleating in agreement or disinterest. Hopefully, we as America's consumers will demand that those who are responsible for our first line of defense in the battle for our health, our personal physicians, must have the power and incentive to provide the utmost in care and treatment available. Our trained medical professionals must have the final word, not some minimum wage flunky looking at a computer screen that tells them what is the cheapest procedure or if a procedure is "cost effective".
You know who to write to, if you truly care. Your representative's addresses are at your local post office. Make your demands or accept what you are given.
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