HMO Gag Clauses on Physicians

Re “A Gagged Physician Cannot Fully Serve the Patient,” editorial, April 21:

There is probably widespread sympathy with your editorial relative to HMO versus physician. You just didn’t present both sides. While covered under a private medical plan, it was discovered that my physician was part-owner in a surgery center. A simple procedure he previously performed in his office for about $75 suddenly became justification for the center at a cost of over six times that amount. At 20% co-insurance, my out-of-pocket cost increased in proportion.

You might say this is an isolated case but isn’t it true that over the past there has been a proliferation of physician ownership in medical care businesses? Is it possible that this alleged contention between HMOs and physicians displaces transgressions previously more subtle? At least, with HMOs, if your editorial is valid, we’re being scalped at a much lower rate.

HARLIE COOLEY

Laguna Hills

* Your editorial about HMO gag clauses shows only one of the myriad ways HMOs restrict patient care. I have seen HMO patients who were not allowed to have biopsy of breast lumps that proved to be cancer, who were abruptly transferred from one hospital to another while still critically ill, who were arbitrarily refused hospitalization, who were forced to accept cheaper but riskier medication than originally prescribed, and who were required repeatedly to change doctors.

The HMO hierarchies defend all this on the grounds that if they don’t do it, they will be underbid by some new group. To “save” money, all have regiments of bureaucrats to micro-manage each patient visit, reams of paperwork and high-salaried administrators.

The answer to widespread abuse of patients is not grudging piecemeal legislative reform but elimination of HMOs, with the funds from their bloated overhead and unconscionable salaries going instead to a not-for-profit single-payer system, with coverage for all and free choice of physicians. Of course, if it were known that I had written this letter, I would immediately be dropped from the HMO I am contracted with, on a trumped-up pretext. Your editorial is certainly right about that!

JAMES N. McCLURE JR. MD

San Diego