Health Against Wealth: HMO's and the Breakdown of Medical Trust.

• Author: Sharfstein, Joshua

Wealth

Maintenance

Organizations

My Patient was lying in the Cardiac Intensive Care Unit, connected to continuous monitors and dripping intravenous lines, but he couldn't stop thinking about his last tip.

"I carried this lady's groceries up to the third floor," he told me. "Soon I was sweating all over. My chest was killing me. I could hardly breathe. I was having a heart attack, and all she gave me was three bucks!"

My patient returned to his taxi and set off for the small community hospital that his HMO had told him to head for in case of an emergency. To get there quickly, he cut through Boston, driving past five leading health centers with state-of-the-art emergency services. Every minute counts in a heart attack, and by the time of diagnosis and treatment at the suburban hospital over an hour later, his heart muscle was irreversibly damaged.

All for a few bucks, my patient lamented, and he was right again. At just 44 years old, the father of three small children, he was a man whose heart had paid a dire price for his HMO's plan to trim the costs of emergency care.

He wasn't alone. As Wall Street Journal reporter George Anders documents in his new book, Health Against Wealth: HMOs and the Breakdown of Medical Trust, many health maintenance organizations (HMOs) and managed care organizations systematically compromise the health care of their members in order to minimize costs to employers and maximize their own profits. An engaging mix of anecdote and statistics, Health Against Wealth makes a convincing case that many Americans are being betrayed by the new health care system.

Emergency care is just one egregious example. When illness strikes, HMO members are often urged to call a special 800 number (rather than 911) and then are routed to particular hospitals chosen on the basis of price. If a member just shows up at an emergency room and receives care, she better hope the condition is serious: If not, the HMO is likely to deny payment, even if the problem was a near-miss. According to a consumer survey cited by Anders, as many as 20 percent of HMO members have not been reimbursed for their own emergency care.

Health Against Wealth reveals other systematic ways that some HMOs reduce costs but compromise quality: drastically scaling back mental health services, cutting off access to top specialists, increasing "the hassle factor" that makes it virtually impossible for a patient or provider to pursue a complaint, and making heroes of...