Word: himmelstein
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Three days later, U.S. Healthcare told Himmelstein his contract was being terminated. David Simon, U.S. Healthcare senior vice president, denies that Himmelstein was canned for anything he said: "Given the fact that he has expressed a lack of comfort with us, we assumed that he no longer wanted to participate and that he would have welcomed the notice that we provided...
What was the "gag clause" that drew Himmelstein's ire? In his U.S. Healthcare contract he found the following: "Physicians shall agree not to take any action or make any communication which undermines or could undermine the confidence of enrollees, potential enrollees, their employers, their unions, or the public in U.S. Healthcare or the quality of U.S. Healthcare coverage." A further proviso stipulated that "physicians shall keep the Proprietary Information and this Agreement strictly confidential." Himmelstein says he found the whole restriction "so obnoxious I crossed it out" before signing. The emended contract was accepted without complaint...
What is it that doctors are contractually bound not to tell people under their care? Most crucially, according to Himmelstein and other critics of for-profit HMOs, the dirty little secret is how their doctors' pay may go up if they limit the treatments they provide or recommend. Himmelstein charges that many HMOs "offer doctors steep financial incentives--what I consider bribes--to minimize care." In his U.S. Healthcare agreement, he says, he was promised bonuses based on a formula for keeping his patients out of hospitals; if the total number of days they spent hospitalized exceeded a fixed number...
HMOs arose and have flourished in the U.S. largely in response to the runaway medical costs engendered under the fee-for-service approach, in which doctors have an interest in doing everything their patients might require, and possibly more than that, provided an insurer is paying the tab. But Himmelstein and other physicians believe the bottom-line philosophy of for-profit HMOs has pushed the pendulum too far in the opposite direction...
...join the type of organization he had previously criticized? "If you want to treat patients these days," says Himmelstein, "you have to become a part of HMOs." Other physicians have felt these pressures and become similarly, if less vocally, disillusioned with HMO practices. One Los Angeles doctor worked dutifully for three years as a neurologist for CIGNA HealthCare, a large HMO. When she advised the mother of a brain-damaged boy that a muscle biopsy might help diagnose the extent of his condition, she was chided by her bosses for suggesting the test. "I was told it was a mistake...