Friday, October 10, 2008

book review, reece personal musings - Managed Care Memoir

A Web-based entrepreneur emailed me yesterday to inform me he would like to sell A Managed Care Memoir: A Physician’s Whistle-Stop Journey, 1983-2003 (Infinity at the Miami Book Fair International and on three of his websites for a mere $149.

His offer tempted me. The book, published by a vanity publisher and offered on, hasn’t sold well and is gathering dust. Yet of my ten books (another, tentatively called The Primary Solution, may be on the way), A Managed Care Memoir is perhaps the one of which I am most proud. The book traces the rise and fall and sidetracks of managed care and features 27 pit stops on the HMO railway.

1. 1983, Minneapolis, The Journey Begins

2. 1985, Minneapolis, HMOs Derail University Hospital

3. 1987, Minneapolis, HMO Speak Trumps Doctor Speak

4. 1990-1995, Oklahoma City, Managed Care on Route 66

5. 1997, New York City, Author Explains HMOs to Big Apple Audience

6. 1997, Cambridge, Massachusetts, Harvard Business School Professor Predicts HMO Train Wreck

7. 1998, San Francisco, Wall Street Journal Reporter Says HMOs Erode Trust

8. 1998, Vail, Colorado, Conference Speakers Says HMO “Shake-Out” Is At Hand

9. 1998, Little Rock, Arkansas, Author Ponders Collapse of Medical Financial Trestles

10. 1998, Nashville, Tennessee, Conference Addresses Failures of Physician Organizations

11. 1998, Minneapolis, Wall Street Backed Physician Organizations Fail to Leave Station

12. 1998, Denver, Health Economists Says HMOs are on Downhill Grade

13. 1999, Old Saybrook, Connecticut, Media Creates Bad Karma for HMOs

14. 1999, Austin, Texas. Patients Ignore HMOs, Care for Themselves

15. 1999, Old Saybrook, HMOs Go Up, Around, and Down the Laffer Curve

16. 2000, Old Saybrook, Hospitals Are Not The Center of the Tracks for HMOs, But They Are for Physicians and Patients

17. 2000, Fort Worth, Texas, Lawyer Lays Roadblocks Across HMO Tracks

18. 2000, New Haven, Connecticut Rail Rage, Connecticut Physicians Sue HMOs

19. 2000. Wilton , Connecticut, A Physician Executive Seeks an HMO Detour

20. 2000, Minneapolis, Another Physician Executive with Another HMO Alterative

21. 2001, Old Saybrook, Software Speeds and Improves Care

22. 2001. Saratoga Springs, New York, Expert Teaches How to Drive on Information Railway

23. 2001, Cambridge, Massachusetts, Harvard Business School Conference Serve as Depot for Consumer Advocates

24. 2001, Minneapolis, CEO of Health Plan Converts HMO into Patient-Driven Locomotive

25. 2001, Cochrane, Georgia, In Busy Practice Physician’s Computer Skills Are Not Enough, An Interview with Ed Roberts, MD. Inventor of the First Practical Personal Computer

26. 2001, Jackson Hole, Wyoming, Father of HMOs Says System Needs Quality Reform

27. 2001, End of the Line and Beyond

Well, that's now ancient history. We’re now 5 years beyond the book. What has happened?

• HMOs are still wildly unpopular (A Harris Interactive Poll, Oct. 2007, indicates only 5% of Americans regard HMOs as “trustworthy,” and 45% say HMOs “need regulation.”

• HMOs are still in the game (They have changed their stripes by emphasizing Consumer-Driven High Deductible Plans, pushing wellness, and profiting from Medicare Advantage Plans.)

• Physicians have brought a class action suit against HMOs and won (The settlement resulted in HMOs contributing more than $100 million to a 501C3 organization known as the Physicians Foundation for Health System Excellence.)

• HMO reform is on the political reform agenda (HMOs, politicians say, should accept everybody regardless of their health status or pre-exiting illness.)

• Health reform is stuck in neutral (This is partly because of heavy lobbying on part of existing stakeholders who like the status quo and partly because of Americans’ distrust of a government dominated health system.)

• Managed care premiums have nearly doubled.

• And lastly, we are in the throes of an unprecedented financial crisis, the dimensions and directions of which are still uncertain but which could lead to a cascading collapse of major health institutions that depend on credit to sustain themselves.

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