HEALTH AGAINST WEALTH

A hard look at how for-profit health management organizations have come to be the force they are in our health care system and how their emphasis on the bottom line threatens quality medical care. Wall Street Journal reporter Anders (Merchants of Debt, 1992) reveals how corporations in the 1980s turned to managed care as a way to hold down the mushrooming costs of employee health plans by taking power away from doctors, hospitals, and patients and putting it in the hands of businessmen. Over 55 million Americans are now covered by HMOs, and their numbers are growing at the rate of 100,000 a week. The entrepreneurs who led the way in this astonishing revolution in our health care system come in for some sharp scrutiny (Anders seems to enjoy deploring their greed and flashy lifestyles), but the main focus is on how HMOs function. Anders examines their impact on hospitals, doctors, the pharmaceutical industry, and of course consumers. Hair-raising stories about the refusal to treat seriously ill patients are featured prominently in his discusion of how cost-conscious HMOs handle heart disease and breast cancer, emergency medicine, mental health, and care of the elderly and the poor. The picture that emerges is disheartening, even alarming, but not hopeless. Anders shows how consumers, doctors, employers, and regulators have been able in specific instances to challenge stingy treatment guidelines, negotiate for better access to specialists, change the rules about use of emergency rooms, and help set better standards of coverage. He concludes by summarizing various courses of action these groups can take to improve the medical care provided by HMOs and by warning HMOs that as society develops a cost-effective medical system, they may find themselves expendable. Highly readable and downright essential for anyone—patient or doctor—in an HMO or considering joining one. (Author tour)