HMO Training and Legislative Reform

I hope I’m not the only one that noticed the irony in your headlines: June 16, the University of California wants to train new physicians in the ways of HMOs (“New Doctors Need HMO Training, Panel Says”); June 17, the state wants to reform these same HMOs (“Legislators Launch HMO Reform Efforts”); and a physician sues a managed-care medical group for wrongful termination (“Doctor’s Suit Over Firing to Be Test of Law”).

I suggest that the art and science of medicine will change more slowly than the business of medicine. While the education of physicians needs to be as broad as possible, including knowledge of costs and community needs, to base medical education on what is a business model will not benefit patients, physicians or the public.

BERNARDO J. MORA MD

Torrance

* Your June 18 editorial on patient rights under HMOs contains a beautiful irony. HMOs exist for economic reasons and a panicky fear of government supervision of health care. It now appears that what we’re going to have is government management of managed care.

The problem is that HMOs are incompatible with our economic system. One can plan to buy a car but not when to have a heart attack. The victim in a car crash is rarely in condition to tell the ambulance driver what hospital to take him to or what doctor he wants to attend him. For practical and moral reasons no one should profit from another person’s ill health, except those who are qualified to heal the afflicted. If this means government supervision, so be it.

CURTIS KENYON

Sherman Oaks

* Your editorial makes several exceptionally important points. However, the legislative process is highly dynamic, and, by coincidence, your gentle criticism of my bill, AB 794, was based on a provision that I amended the day before the editorial was published.

You argued that the physical exam portion of my bill would ultimately be too expensive. After working with hundreds of doctors, nurses, patient groups and others, I came to agree that this requirement, if imposed in all cases, would indeed be unrealistic.

My bill now permits HMOs to review the patient’s medical records unless the original treating physician finds that the case involves a significant problem that cannot adequately be reviewed without a physical exam. This seems to me to balance patients’ right to have a meaningful review of their case against the HMOs’ valid economic concerns.

And AB 794 gives patients the secure knowledge that if a review of their case cannot adequately be made based on the paper record, care will not be denied until a second physician has seen them in person.

LIZ FIGUEROA, Chair

Assembly Insurance Committee

D-Fremont