Word: hmos
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...Permanente, the giant HMO with the imperial name, announced that it had decided not to cover the cost of the $10 erection pill for its 9 million members. Just three weeks later, the little pill had become a symbol of one of the nation's hottest political issues: what HMOs do and don't pay for. Viagra's role in the debate was heightened last week when the federal agency that administers Medicaid told the states that they were required to cover Viagra for the indigent and infirm "when medical necessity dictates," and some of the states--much like tightfisted...
...glove with the insurance companies. Today 85% of all insured employees--up from 53% five years ago--have moved out of traditional fee-for-service plans, in which doctors call the shots and insurance companies pay the bills, and into managed-care plans, including health-maintenance organizations, or HMOs. Almost every aspect of medical care provided by HMOs is second guessed--not by the government, not by Hillary, not even by doctors, but by the bean counters...
...conducted last week suggests that the country is of two minds about health reform. Although 85% responded that they were "very satisfied" or at least "fairly satisfied" with the quality of medical care they receive, 68% said they think traditional fee-for-service plans provide better health care than HMOs, and only 41% of those covered by managed care said they were "very confident" that their plan would pay for their treatment if they got really sick...
Whether Kaiser's policy will stand is another question. Last week officials from California's department of corporations, which licenses the state's HMOs, announced that they are investigating Kaiser's decision on Viagra. At issue: a state law that requires health plans to cover all treatments that are medically necessary. Believe it or not, there are situations in which Viagra could qualify as a medical necessity. For example, many men refuse medical treatments, such as prostate surgery, for fear they might be rendered impotent. Viagra could allow them to proceed with a life-saving operation without diminishing their quality...
...past four years. But with fewer people worried about losing their jobs and the health benefits that go along with them, the uninsured and their tragic stories barely figure in the debate. Instead, politicians have taken up the cause of the Great Insured Majority against the employers, HMOs and insurance companies that would deny them proper care. "How can you let some person with the mentality of an accountant...make the decision?" Clinton has demanded...