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 atime where we may see these ideals crumble like dust in the wind. HealthMaintenance Organizations, HMOs are currently depriving millions of peoplefrom quality health acre and freedom of choice.
This is occurring because peoplewho are enrolled in HMOs are unable to choose the doctor that they want. Alsopatients lose the quality of care because HMOs interfere with the health careproviders decisions. The Health Maintenance Organization has been proven to”sometimes interfere with physicians exercise of sound medical judgementand avoid covering necessary medical care, causing members to either pay out oftheir own pockets or go without” (Schlossman). This means that the insurancecompany does not really care about you.Order now
The insurance company only cares abouthow much money it has to spend on you as a person and if you need a type ofspecial care that cost money either you can pay for it your self or just gowithout the care that is needed. This interference often compromises thepatients ability to have freedom of choice in selecting a provider and to getthe best quality for their health care needs. This freedom of choice is theability to choice the doctor that you want as a doctor. Yet instead HMOs pickthe doctor for you. All over the United States HMOs have denied patients themedical care which they need.
In Charlotte, North Carolina, for example, a boynamed Ethan Bedrick was born with cerebral palsy. His doctors said that in orderfor him to be able to ever walk, he would need extensive therapy. Yet accordingto HMO policy, patients are only allowed a maximum of fifteen therapy sessionsper year; therefore, his health plan said “NO. ” The HMO said no when alittle boy said please help. This proves why HMOs frequently deprive patientsof the optimum quality of life. This little boys future of being able to walkwas crushed by an insurance company that was so money grubbing greedy that itcould not stretch the rule for this case.
Since the boys therapy is not beingpaid for the HMOs gets a bonus in their paycheck. They took the money that wassupposed to go to the therapy and put it into their pockets. An epidemic hasoccurred in most senior citizens lives. Since January 1, 1999 440,000 seniorcitizens have lost their HMO privileges.
In essence, HMOs decided toarbitrarily eliminate the senior citizen plan. The sad reality is that manymembers who subscribed to these particular HMOs for its senior citizenspackage are out of luck and without medical coverage. For many people over theage of 65 who once had HMO benefits are now scrambling to find a new insurance. There are people like Allen Martin from New York, who is over the age of 65.
Dueto a severe disease his kidneys do not work. As a result he needs dialysis,(which is when the waste material is flushed out of the body) three times aweek. This process is extremely expensive costing hundreds of dollars each timeand what was once paid for by the HMO, but now he has to find some way to payfor it on his own. In many cases doctors are unable to tell a patient thelimitations of their particular HMO and how it interferes with the ability toprovide good medicine.
This is called the “gag rule”. These gag rules do notallow the doctors to say anything bad or against HMOs. Also the rulesrestrain doctors from telling the patient certain things that HMOs do not payfor such as special procedures that might benefit the patients condition. Doctors who work with HMOs have to sign a contract. This contract states thata doctor is unable to tell patients certain things. Yet in frequent casesdoctors have felt limited by their contract with HMOs.
This is because theywant to tell patients important facts, but are unable to because of thecontract. If the doctors break this agreement, they stand to lose theircontract with the HMO. The Health Maintenance Organization created a situationwhere patients have lost the ability to select the doctor of their choice. Inaddition, many plans have something called a “Gatekeeper”. The gatekepper isa business man who probibly does not know anything abnout medicine or