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Managed Care for Profit Not Answer

By Mark Green, MD  Posted by Margaret Bassett (about the submitter)       (Page 1 of 1 pages)     Permalink    (# of views)   1 comment

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This morning I read this online in my local paper & QuickLinked to OEN. I wrote to Dr. Green asking him if we could print the letter. He has replied and gave me permission to publish it. (BMH means Blount Memorial Hospital) Letter to Editor appeared in The Daily Times, Maryville, Tennessee on August 27, 2008 Margaret Bassett

Dear Editor:
Recently, there has been news of changes in regional managed health care ownership. Most will consider this as general business information and will not consider it further. Many others will understand it for what it is, a further consolidation of the "for profit" insurance industry. An industry that will maintain their profit margin at the expense of actually delivering health care. In fact, the monies that are spent on patient care by this industry is universally termed the "medical loss ratio." If it's not profit, it must be loss! If anyone denies profit is involved, consider the sums of money that are slated to change hands in the recent announcement.

There is no love lost between physicians and companies of this type, and it is not due to the decline in salaries. Rather, it is knowing that the number of mind-numbing pre-authorizations for medications and procedures is only going to go up as is the endless stream of paperwork and chart reviews. The latter designed to maximize profit at the expense of patient confidentiality. The insurance industry has only two ways to maximize profit and thereby minimize the "medical loss ratio." By encouraging patients to be more healthy and by restricting each patient's medications and testing. We all want to be more healthy, but we also want any medications and any testing that is deemed necessary.

The power of the health insurance industry has become nearly absolute. I have recently been contacted by a local health insurance company who wants me to set aside space in my small office for them to come in for 2 to 3 days and set up a copying machine to copy nearly 100 charts. They will then take my patients' private information out of my office for review by persons I cannot observe at a site over which I have no control. They say this information is kept private, but considering they are doing this across the area, they must have hundreds of reviewers looking through this information.

The law of averages demands that periodically charts will be read by reviewers that just happen to know the patient involved. Information such as HIV infection, breast augmentation, depression and marriage issues will be known to those reviewers. I would like to feel the average reviewer would keep this information secret, but I would hate to bet my health information on it. In contrast, other insurance companies will request 10 to 20 charts to be gathered and they review them in my office. I have no problem with this approach as patient privacy is less compromised.

I have developed a long list of local managed care abuses of power and could give many other examples. In respect to brevity, I close with the hope that America will soon realize that profit-centered managed care is not the answer to our woefully inadequate health care system and that it only allows this industry to take money out of an overstressed system at the expense of patients' health and of providers' sanity.


Mark Green, MD
463 BMH Physicians Bldg.
Maryville TN, 37804


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Margaret Bassett passed away August 21, 2011. She was a treasured member of the editorial team for four years.

Margaret Bassett--OEN editor--is an 89-year old, currently living in senior housing, with a lifelong interest in political philosophy. Bachelors from State University of Iowa (1944) and Masters from Roosevelt University (1975) help to unravel important requirements for modern communication. Early introduction to computer science (1966) trumps them. It's payback time. She's been "entitled" so long she hopes to find some good coming off the keyboard into the lives of those who come after her.

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