Parting the health care crisis

The number of uninsured people in California is at an all-time record high. The number of physicians who are opting to retire early and no longer practice is also at a record high. Jordon referred to this trend of physicians who are "in the prime of their career getting out of the practice of medicine" as a silent protest and blames HMO's. According to Jordon, the HMO's have out and out refused to negotiate with Doctors or compensate them fairly.

"They have ruined the practice of medicine is what they've done." Jordon added.

According to Bobby Pena, the vice president of communications for the California Association of Health Plans, the HMO's are simply the faceless scapegoat in this blame game.

"Physicians are very quick to blame managed care programs. One of the issues we're facing in California is that we have the lowest premiums in the country," said Pena. "That's great for small businesses, but on the other hand it's not great for consumers, hospitals or doctors."

Pena went on to say that the profit margins for managed care programs are between 1-3 percent, and that allegations that managed care is getting rich and leaving the poor and the elderly under-served is simply not the case. In the defense of managed care, Pena brought up two major points: One is that while the premiums remain consistent the cost of pharmaceutical drugs are rising dramatically (approximately 20 percent). The rise in the cost of drugs is taking a larger and larger chunk out of already depleted resources - that must then be spread over a growing number of people.

He also stated there needs to be better management of health care groups and individual IPA's. Several health groups are surviving and thriving at competitive rates yet the San Mateo IPA was not able to, according to Pena.

The Wild Card in all of this, according to Pena, is that no entity has been regulating the medical groups.

In California, there is a third party in the health care crisis, directly linked to both the Doctors as well as the HMO's, they are the separate medical groups and centers, often times referred to as IPA's who have been going belly up, leaving unpaid debts owed to Doctors and people uninsured. The San Mateo IPA, a health care group that has been operating in San Mateo County for more than 23 years has recently closed their doors.

According to Jordon, however, it is the HMO's that are chiefly to blame. "The IPA was a complete failure from the beginning. But what I'm talking about are HMO's - The Blue Shields and AETNAs."

According to Jordon, the HMO's have deliberately milked the system and dumped the bulk of the ailing onto "the backsides of [Emergency Rooms]."

The heated argument over who is to blame for the lack of health care in San Mateo County will continue. Doctors are pointing their fingers at the HMO's and the HMO's are blaming the legislature for not fully funding health care programs. In the end, the access to health care for those who really need it is still in the hands of large, inaccessible and battling entities.

Next week we will attempt to interview administrators at Mills-Peninsula Hospital, one of the few financially solvent health groups in San Mateo County.

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