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Politics : Politics for Pros- moderated

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To: Lane3 who wrote (125749)	7/18/2005 10:17:48 AM
From: aladin	Read Replies (1) of 793807

Karen, I used to work in the health insurance/hmo industry. HMO's such as Kaiser and Harvard Community Health Plan have been around a long time and operate on whats called a 'staff' model. In this traditional model the non-profit HMO reduces costs by limiting a memebers choices to their facilities. It also reduced costs by requiring new members to come in for check-ups and having regular ongoing visits (ie the 'Maintenance' component. All in all a stich-in-time-saves-nine model. New HMO legislation came out under Nixon promoting this concept, but by the late 1970's it found several new variants. These included 'Group', 'PPO' and 'Capitation' models as well as variations that were profit based. The trouble with HMO's is partly due to some of the newer operators acting fast and loose in the 80's and partly perceptual. For example on the perceptual issue - if I had BCBS insurance - I could go anywhere and receive any treatment. There may be discounts at some facilities or large co-pays at others, but I get choice. Now as a an employee of a company I get BCBS for my family at $110 per pay period or I can look at HMO Inc at $65 its not readily aparent to me that HMO Inc will not send me to the Mayo Clinic for a heart transplant. Now when I contact heart disease I sue HMO Inc because the bastards won't give me the health care I didn't pay for.. Now there were some bad actors in the '80's, but today they are well regulated. Today's HMO's look a lot like what Nationalized Health Care looks like in Britain or Canada (but they are better here because at least for now they have competition - not just with each other, but also with traditional insurance). Generally you agree to certain restrictions in your choices and in return have lower costs. John

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