William J. 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 there." 

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 ERISA statutes

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).