Wednesday, November 12, 2008

How Does "Managed Care" Become Mismanaged?

I have found many people who have issues that are coincidentally, if not painfully, linked to the period in their lives when the local doctors became the "HMO" doctors. Health Management Organizations, Health Maintenance Organization, Harried Murderers Organization. When administration of health became the primary purpose of health care, health CARE seemed to walk as far away from the Hippocratic Oath as vampires from garlic.

My first view of HMO's was when I was still on the base in Little Creek, Virginia. A friend of mine, and wife of a sailor who had been away from her for almost six months, was very, very pregnant. She was almost about to pass an adult. The base was under the Reagan Doctrines, and many of the benefits of being part of the military were shuffled away, so that cash could be diverted to better things. No idea what these better things were, but during the eight years he was in office, many of the Veterans and members of the armed forces were only given bonuses and benefits if they signed up for longer than six years, or re-upped. From 1980 until 1987, many of the people who were using the military for earning money to go to college, for instance, lost much of that benefit. Wives and family members of people on many bases were given the option of using "HMO" care rather than base hospitals.

My friend decided that her child would best be served by a civilian doctor, and she and her husband opted for her to sign into the HMO system offered by the military. Virgina was one of the first states to test out this management system and it was supposed to help streamline medical care, offer stability of services, and even serve to give a person ONE doctor to deal with for her entire life. We all know what has become of this form of medicine. The idea that hospitals could cut costs by cutting care became the modus operandi. At this time in the history, however, there was still the idealism that the doctors would be the leaders in this new form of practice.

She went into a hospital and was shuffled from station to station until she finally met her ob-gyn, approximately four minutes before delivery. Then, a week later, her bill was all of $35 dollars. I thought, "This HMO stuff is GREAT!", and I couldn't wait until I was eligible to sign up for the same. After I was discharged, I had no idea that I qualified for Veterans Hospital benefits for a service aggravated injury. All I knew is that in Boston, I could go and sign up for Harvard Medical care, and that's exactly what I did....only having one story to go by.

The first doctor I saw went through my records from the Naval Hospitals, and saw, "depression", and "ehlers-danlos", and that's all I ended up hearing about for the next few months. One day, he said, "We're testing new medications for people with joint diseases, and you can qualify for the trials." But it wasn't medication for the bones and joints- it was an antidepressant panel. I was given epilepsy medications for the first time.

I was told that if I kept in the "trial" programs, my fees for the HMO would be waived, or reduced by up to 80%. As a student, in an art school, I thought that was a fantastic deal! I could see specialists, and my doctor, and get treated for my illness- for almost three dollars per visit? This HMO program was amazing! What I didn't know was that my care was going to be given over to another doctor, and I was placed under the "mental health" department.

It was here I was tested for sleep issues. I was given exams for epilepsy. I was given liver function tests nearly weekly. I had blood drawn and new medications handed to me every few weeks. For almost three years, I had no idea if I was feeling better, or if I was so medicated, I was sort of feeling okay, for just that moment. I do know that I ended up with mono- that showed up in my blood for seven full years. I do know that I ended up with bronchial issues, including pneumonia, which I was told was a side effect of one of my medications. It took almost four months to recover from this, and it was so drastic I ended up with throat scars for coughing so much.

In my mind, I was being treated by HARVARD MEDICAL, and I knew that was supposed to be the best in the world. I hadn't heard of the Mayo Clinic, and I had no idea what National Institute of Health was. One doctor was convinced I had petit-mal epilepsy because I was so spaced on meds. Another one said I was having too many problems with depression to have epilepsy. The pair of them sent me on a three day exam, that included a 24-hour no-sleep allowed test. Both of them were so intent that each was correct, that I was shuffled back and forth between the two for months. I finally said to the "depression guy", I was tired of talking to him about my life, and I wanted him to taper me off the test meds.

The HMO didn't want that. I was being used to test a valuable product, (I still don't know if I was on Effexor or Wellbutrin, but I am guessing it was one of these because of later similar side effects I experienced on both.) I do know I wasn't part of the "placebo" group because I was shown blood tests that were just scary- high bile content, low enzyme content etc etc etc. Just nothing ever in the "normal" range.

The cycle was broken when I was accepted to graduate school in California, which meant I couldn't be part of this program any longer. I had been given my first mammogram, (at age 23), and was told I was having problems with "dense tissue", that was likely poly-cystic. That was the last set of tests I was given before I started the drive to Los Angeles, and the detox from the medications. By the time I was in my first semester at Cal Arts, I was only on Tegretal and birth control pills. This was a reduction of nearly a dozen different medications.

I thought I was out of HMO care forever, until, in 2002, I was talking to my Veterans Administrator about discharge paper copies, and she asked if I had realized I was supposed to be able to use the VA for their health care from the day I was let go. I had no idea. But, I did know by this time, I was so ill and so broke from paying for private medicine, that the idea of being under this program was a relief. More on this another time...

Today's question- When did you discover the HMO sytems, and did they serve you at any point? What would be a good socialized medicine program, or is that not something that could exist? How do you ensure you have correct care when the doctors are only looking at specific cost cutters?

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