Patient: I’d like this prescription filled. Druggist: That will be ninety eight dollars. Patient: How much is the placebo? (After Parker)

A recent FP-HMO (For Profit Health Maintenance Organization) merger netted nearly $1 billion for one individual. The profit from health care dollars for this one individual would have covered the health care overhead for two employees of every physician in the United States of America. Or to put it more succinctly, it would have provided a basic entry level HMO policy for one million poor people for an entire year. Isn’t converting health care dollars into personal fortunes racketeering? Or at least fraud? Isn’t that what they said doctors were doing who ran efficient labs in their offices at half the price of the competition? Looks like despite all the encumbrances, Health Care should move forward to a position it once had in the Non Profit Insurance and Non Profit HMO world.

Kudos to the Kaiser Foundation Health Plan of Northern California for placing third in the nation in Newsweek’s recent report ranking America’s 43 largest HMOs.

Overheard in the Staff Lounge when physician job security was being discussed: Why should doctors have more job security than John & Jane Q with an ordinary job?… Are we comparing ourselves and our investment of hundreds of thousands of dollars into our 6-10 years of post college professional education and training with the average John & Jane Q, who may even have a union protecting them? In a free society with the freedom to practice the best medicine for our patients, the doctor providing the best care received the rewards including recognition. As we become a third party controlled profession, it no longer is what we know, but who we know and our willingness to compromise to maintain that favor.

Wells Fargo announced that they can’t close branches fast enough to save money, even with the closing of three-fourths of the First Interstate Branches they just bought. They are now considering opening up drug stores in some of their branches… St Joseph Health Center in Kansas City, MO decided rather than make deep cuts in spending, they would look for new revenue sources. So they built a shopping mall-style food court that generates a profit… A Chicago hospital put in a full physical fitness center… Maybe our hospitals should consider a similar conversion of facilities. How about a banking center next to the gift shop?

The Wall Street Journal showed a cartoon in which the FP-HMO told a patient that they had approved the requested surgery. However, if he would be willing to decline the operation, they would give him 5 nights and 6 days in Barbados… How about a travel agency between the gift shop and the ATM right next to the business office?

A recent study on the value of autopsies indicated that they are being used less frequently. With modern sophisticated testing, accurate diagnosis are achieved in over 80% of patients and, therefore, the need for post mortem examination is decreasing. In fact, in those 20% that uncovered additional diagnoses, including cancer, nearly all of them are basically of academic interest only… Perhaps hospitals could use some of their excess space, such as the old autopsy/morgue area, for a mortuary. Hospitals would then truly give bassinet to crematorium total care… Like the autopsy, the crematorium may not a covered HMO service.

An East coast HMO organization related to me that they are now selling “Major Medical Insurance” in addition to their basic HMO plans. Canadians are their largest market. He stated that with government medicine in Canada, patients are having to wait 6 to 18 month for major surgery, such as coronary bypass, hip replacements, and transplants. They are willing to pay a significant premium for a one to three thousand dollars deductible policy which gives them the option of obtaining the operation in the USA.