and the Genesis of Managed Health Care
Managed health care was born in Minnesota in 1969 when pediatric neurologist,
Paul M. Ellwood left the practice of medicine to initiate national health
reform. During his tenure as executive director of the American
Rehabilitation Foundation and the
Sister Kenny Institute in Minneapolis he
recognized that the United States Government was becoming more and more involved in the
planning and funding of health care as demonstrated by its introduction
of "Medicare." He, and his associates regarded Medicare as the advent of a disturbing
trend towards socialized medicine. Because of this he intended to
introduce the "health maintenance organization" (HMO) as a better
alternative to a socialized system. Elwood's goal was to initiate a new direction in health care which would not only provide quality service
to the public, but would also contain escalating health care costs by preventing
disease and also maintain good
health in the population.
This experiment in health care was first
introduced in Minnesota as the organization "Group Health."
As the "true colors" of this experiment in denying care became evident, the
treating Minnesota physicians began to simply ignore denials of patient care
and went ahead with what was in the best interest of their patients
(rather than the best interest of Group Health).
||The reasons behind Group Health's initial survival
are interesting to speculate. An important pioneering medical
influence in Minnesota has clearly been the influence of the Mayo brothers (Charles to the
left and William to the right).
Mayo, M.D. believed in, and promoted, the Hippocratic
credo: "the patient comes
first." Because of the well-established "Minnesota
Ethic" in patient care this HMO "trial
balloon" looked a great deal
better to the casual observer than it really was. The initial skewed "good grades"
from Minnesota provided
national HMO watchers with a
false sense of success. The present status of the HMO movement in
Minnesota today is well summarized by Paul Saunders, M.D., Chief Executive of the Minnesota Medical
Association "We are a little surprised that they [managed care] just
now are acknowledging the amount of consumer distress and distrust out
Sadly, HMOs did not become what Ellwood and associates originally intended.
Regrettably, for the public, the well-intended HMO model became a "cash
cow" for overly greedy business interests whose primary goal has been to suck billions of dollars
out of the health care system in order to fill their corporate pockets.
The HMO practice of withholding and/or denying care thus became the
stuff of legend.
The HMO practices of charging their clients
"retail" while themselves paying "wholesale" is a tale
well known to many state's attorney generals and uninsured patients who
have been hit with full retail costs. These and other abuses
have initiated a grassroots public demand to restore real (not the
politicized) "patient rights" and to influence the United States Congress to pass legislation to
attempt to right the many wrongs being suffered by disillusioned and
harmed patients. How many incapacitated individuals have received letters such as this
from their HMO as a justification for denying prescribed treatment?
HMO behavior intending to insinuate themselves into being the absolute
arbiters of their client's health care destiny is now abundantly clear . In fact they have (despite their denials),
been actively engaged in the practice of
medicine. In this endeavor they continue to be aided and
abetted by the United States Government which continues to provide the managed care industry with a truly astonishing and unique legal immunity
against being held responsible for their often contemptible behavior. The basis by
which this aberration has been allowed and maintained are the
It would appear that Dr. Paul Ellwood, and his subsequent InterStudy
organization, did not expect that the control of their HMOs would be by business
executives and corporate shareholders committed only to their own fiduciary
motives rather than medical professionals
committed to a higher ethic. In 1997 Dr. Ellwood
admitted, in an interview, that his vision had failed to be fulfilled.
His candid observation was also shared by the Minnesota medical
community. In 1999, it was reported by physicians
that 87% of their patients had experienced some denial of coverage over
the previous 2 years and a study released in 2000 by Kaiser Health Plan
and Consumers Reports indicated that 50% of Americans surveyed had a
problem with their health insurance during the previous 12 months (Landro
L: National Group Goes To Battle for Patients Fighting Their Insurers,
Wall St. Jour., July 7, 2000).
|The United States Congress continues
to wrestle with patient's rights legislation and alternatives to managed
care and socialized medicine. President George W. Bush has proposed a
vision of a stronger, more patient oriented health care system. A
similar thought has been advanced by a group of health reformers at a
meeting of the Jackson Hole Group. Remarkably, Dr. Ellwood is back
again heading a new charge. This time he is proposing a voluntary
system of electronic medical records that would be transportable over the
Internet (owned by the individual patients). By making this
information available to health care providers it is Dr. Ellwood's thought
that the advent of new technologies would not only provide patients with
better information on treatment modalities but could also serve as a means
of providing comparative data on physician performance. Dr. Ellwood
is now also proposing the creation of a new Institution for Medical
Technology (Landro L:Health Care Reformers Regroup
in Jackson Hole, Wall St. Jour., Oct. 2, 2002).
Well, Dr. Ellwood is certainly due to hit "a mother lode" given
his many years of prospecting. Burton Report®
is clearly an advocate of placing the patient
in the driver's seat
but, we wonder how the federal government could possibly keep it's hands
off a "private" collection of patient medical records.
Also arrayed against this innovation is the power and financial assets of
a, now huge, managed care industry monster created by the very same
Dr.Ellwood. Is this another example of déja vue all over again?