Where I Stand — Brian Greenspun: Insurers finally get it

Tuesday, Nov. 30, 1999 | 9:08 a.m.

Brian Greenspun is editor of the Las Vegas Sun.

THE FIRST STEP to recovery is admitting that you have a problem.

I know we have all heard those words before since they are the basis for the best advice ever given to a person with an addictive disease. Whether they are heeded, of course, is always the challenge to getting better.

It is no longer a rarity to hear those words uttered in polite society. We have become enlightened enough as we approach the end of the 20th century to realize that people are, indeed, humans who need a helping hand from time to time. Even though we have learned to accept this reality for individuals, it still comes as a shock that one of the largest industries in the world would be willing to do the same.

I speak, of course, of the multibillion-closing-in-on-a-trillion dollar health care industry that recently threw another public relations surprise at the American people. First, the UnitedHealth Group -- the nation's second largest health insurer -- dropped those ugly rules which required doctors to get prior permission for tests and other needed treatments before they could act. It was a voluntary move to be sure, but one that has sent signs of encouragement throughout the industry that other insurers would follow suit.

There are many who have said that this move by United, while certainly a welcome one, is far too late for those Americans who have suffered needlessly because insurance company clerks were required to approve medical decisions that only doctors should have been empowered to make. And those critics would be absolutely right. I remember not too long ago when members of the Clinton administration went around the country predicting that insurance companies, not doctors, would make the life-saving decisions or, more correctly, not make them. And while their fix to the problem may not have been the best one at the time, the prophecy was right on the mark.

It is now six years later and, yes, there have been a number of needless deaths and other horror stories attached to our collective refusal to act. But now it appears that the health care industry is finally getting the message that the people in this country are no longer willing to tolerate the emasculation of the physician-patient relationship.

A memo circulated among top health plan executives recently places the blame for the public's unrest and distrust squarely where it belongs. And that is on the insurance companies and HMOs, which took health-related decision making away from the doctors in America and placed it in the hands of people driven by motives far removed from the Hippocratic Oath which has served our health needs better than any other country on Earth.

No longer are the HMO providers relying on fancy image campaigns to sway public opinion, because they can't. No amount of television commercials and newspaper ads can convince a nation that life is good when everyone in the system knows that things are bad. It is this new-found knowledge and understanding that problems in the delivery system itself are the major contributor to the public's dissatisfaction with the way things are. So, in an effort to divert pending legislation by Congress aimed at fixing what is wrong, the industry is acting in its own best interests by trying to fix the problem itself.

That is very good news. And while it may be too little, too late to stop a national cry for help from our lawmakers, who can insist that doctors and not profit-driven insurance companies care for the patients, it may blunt legislation that might otherwise be too limiting on the desires of those major companies.

What has happened in health care is no surprise. Like every other good idea in America, once put into practice it loses its sense of purpose and becomes something other than what was intended. There is no question, for example, that our health care system has been gravely ill these past couple of decades. The cost of medical services and the insurance programs designed to give them effect had grown astronomically to the point that few Americans could even afford adequate treatment.

The HMO was developed to control the costs and spread the risk among greater numbers of people, thus making good health care delivery available to more patients. It was a good idea. What happened, though, was that profit motivation led those who controlled the HMOs and insurance companies to squeeze the costs out of the doctors and hospitals but not out of the system at large. That meant greater profits for those companies but only if they could keep a lid on the cost of providing the medical services.

No one begrudged the HMOs their significant profits for acting as intermediaries to fix a problem that was consuming us as a nation. In fact, we welcomed it. But to pull off the cost-cutting trick required the insurance providers to "just say no," whether there was a need for the treatment or not. And that kind of attitude has brought the problem to the steps of the U.S. Congress, which nows appears willing and ready to respond to overwhelming constituent unrest.

The good news last week has definitely been a recognition -- whether it be for public relations value or for a more responsible reason -- of the fact that insurance companies and HMOs have gone too far. So if the industry can clean up its mistakes, curtail its excesses and return the health care system back to the doctor-patient relationship where it belongs, then the people and the health care businesses will be the winners.