One of the most powerful indictments of the managed care industry,
this scathing exposé presents case histories of those who have lost their health or
their lives because an HMO denied or delayed vital treatments, tests or surgery. Consumer
activist Court, advocacy director of the Foundation for Taxpayer & Consumer Rights,
and public policy consultant Smith zero in on the insidious incentive for HMOs to withhold
medical care in order to increase profits, thanks to the current capitation system, which
allocates a fixed lump-sum payment for every patient under a provider's care, regardless
of how much treatment each needs. HMOs, as portrayed here, are institutions driven by
shortsightedness, negligence and greed, in which clerks without medical licenses overrule
treating physicians to make life-and-death decisions, accountants scale down medical procedures
and determine patient discharge times, and taxpayers are cheated out of billions by distorted
federal expense claims for reimbursement. The authors set forth an arsenal of sensible
proposals for reforms that would level the playing field for patients. An appendix, "HMO
Patient Self-Defense Kit," offers practical pointers on how readers can negotiate with their
HMOs to get the care they need. This lively probe is must reading for anyone concerned
with the health of the U.S. medical system.
Publishers Weekly, Nov. 22, 1999
Provides one of the most descriptive records of the horrors of HMO medicine during the 1990s, with numerous stories of individuals who were denied care or had to fight their HMOs for coverage of medical services. Court and Smith make a compelling case for the absurdity of a health-care system based on the concept of minimizing care to increase profits and please shareholders. They reveal how and why most HMOs have broken their early promises to control costs and reduce the number of uninsured Americans.
Los Angeles Times, Feb. 28, 2000
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