Throughout history, America has always strived for freedom and quality of life. Wars were fought and people died to preserve these possessions. We are now in a time where we may see these ideals crumble like dust in the wind. Health Maintenance Organizations (HMOs) are currently depriving millions of people from quality health care and freedom of choice.
This is occurring because people who are enrolled in HMOs are unable to choose the doctor that they want. Also, patients lose the quality of care because HMOs interfere with the healthcare providers’ decisions. The Health Maintenance Organization has been proven to sometimes interfere with physicians’ exercise of sound medical judgment and avoid covering necessary medical care, causing members to either pay out of their own pockets or go without” (Schlossman). This means that the insurance company does not really care about you.
The insurance company only cares about how much money it has to spend on you as a person. If you need a type of special care that costs money, you either have to pay for it yourself or go without the care that is needed. This interference often compromises the patient’s ability to have freedom of choice in selecting a provider and getting the best quality health care. This freedom of choice is the ability to choose the doctor that you want. However, instead, HMOs pick the doctor for you. All over the United States, HMOs have denied patients the medical care they need.
In Charlotte, North Carolina, for example, a boy named Ethan Bedrick was born with cerebral palsy. His doctors said that in order for him to ever walk, he would need extensive therapy. Yet according to HMO policy, patients are only allowed a maximum of fifteen therapy sessions per year. Therefore, his health plan said NO.” The HMO denied a little boy’s plea for help, proving why HMOs frequently deprive patients of the optimum quality of life. This little boy’s future of being able to walk was crushed by an insurance company that was so money-grubbing and greedy that it could not stretch the rule for this case.
Since the boys’ therapy is not being paid for, the HMOs get a bonus in their paycheck. They took the money that was supposed to go to therapy and put it into their pockets. An epidemic has occurred in most senior citizens’ lives. Since January 1, 1999, 440,000 senior citizens have lost their HMO privileges.
In essence, HMOs decided to arbitrarily eliminate the senior citizen plan. The sad reality is that many members who subscribed to these particular HMOs for its senior citizens package are now without medical coverage. Many people over the age of 65 who once had HMO benefits are now scrambling to find new insurance. There are people like Allen Martin from New York, who is over the age of 65.
Due to a severe disease, his kidneys do not work. As a result, he needs dialysis three times a week. This process is extremely expensive, costing hundreds of dollars each time. It was once paid for by the HMO, but now he has to find some way to pay for it on his own. In many cases, doctors are unable to tell a patient the limitations of their particular HMO and how it interferes with the ability to provide good medicine.
This is called the gag rule.” These gag rules do not allow doctors to say anything negative or critical about HMOs. Additionally, the rules restrict doctors from informing patients about certain procedures that HMOs do not cover, even if they could benefit the patient’s condition. Doctors who work with HMOs must sign a contract that prohibits them from disclosing certain information to patients. However, many doctors have found themselves constrained by their contracts with HMOs.
This is because they want to tell patients important facts, but are unable to because of the contract. If the doctors break this agreement, they stand to lose their contract with the HMO. The Health Maintenance Organization created a situation where patients have lost the ability to select the doctor of their choice. In addition, many plans have something called a Gatekeeper”. The gatekeeper is a businessman who probably does not know anything about medicine.
