- Del Meyer, MD - http://delmeyer.net -

Maintenance Mania

National Public Radio had a report on the success of HMOs. They suggested that there were other things that were expensive and we might apply HMO techniques to bring down their costs. I didn’t have my recorder in the car and so am describing this 100% from recall. My apologies to the author inasmuch as I have probably missed a few words and also missed her name.

Everyone knows the price of cars is too high. To get the price down, we could form a car maintenance organization (CMO). Our CMO executives would tell the dealers that they would henceforth be re-imbursed at 60% of retail costs for the members of the CMOs that purchase cars. The car maintenance organization (CMO) would sign up potential car buyers, which eventually would include almost everyone. The CMOs would enter into contracts with the various dealers to acquire the cars. The dealers, in order to protect themselves, would form Independent Dealers Assns (IDAs). As the number of consumers joining these CMOs increase, the car dealers would not have enough business to go solo and eventually would have to contract at the reduced price. Americans would enjoy the pleasure of driving their automobiles at a 40% savings.

We also know the price electricians charge is too high. The charge of $65 to come to your house plus a labor charge of $65 for an hour or fraction thereof, can amount to $130 for a ten minute job. If 47 million unfortunate Americans with hazardous wiring in their homes could not afford electrical upgrades, the need for an Electrical Maintenance Organizations (EMO) would become obvious. The deserving public living in electrically hazardous homes would join an EMO which would in turn contract with the electricians for their services at $35 a hour (which just happens to be what the latest data shows that doctors in the 25th percentile income, working 3,000 hours per year, are making). As more and more Americans sign up with an EMO, the electricians wouldn’t have any work unless they contracted with our EMO and so we would be able to get the electrician’s hourly rate down to $35 an hour. (Thus the EMOs would bring skilled labor down to the same cost as professional labor.)

Everyone agrees that athletes are definitely making too much money. In fact the cost of professional sports is so high that deserving school kids have difficulty seeing their heroes in action. Why should a jock get $3 million dollars for 20 weeks of work? That’s $150,000 for a 30 hour week–about the same as the 50th percentile for family physicians for a 3000 hour work year. Sport fans should form a Jock Maintenance Organization (JCO) and the public would join these JCOs for the purchase of tickets to football, basketball, baseball, and hockey games that contracted with our JCO. As the coliseums become emptier and as the jock salaries fall, league managers would contract with our JCO to re-acquire fans. We and our deprived children would then be able to see NFL, NBA, NHL, AL & NL games at about 40% or $8 each, as the players learn to live on a doctor’s salary.

The HMO’s CEOs are definitely making obscene amounts of money. Even our local boys are making $5,000 ($5K) per hour. One national HMO CEO made $1 billion. Suppose he worked real hard, maybe three-fourths as hard as some doctors, and put in a 3,000 hour work year? That would be $333K per hour. (Even Bill Gates, the world’s wealthiest man only makes $55K per hour.) What we need is a CEO-Maintenance Organization (CEO-MO). People would join a CEO-MO which in turn would purchase their HMO insurance. But they would only purchase HMO insurance from those that maintain a contract with our CEO-MO which would require that their CEOs starve themselves on a primary doctors average salary. They would also be required to keep their profit and overhead the same as Kaiser. This would mean they would have to reduce the fat from 33% to 8%, a 25% health care cost savings. The shareholders would lose interest and the price per share would plummet. With the price per share below a quotable price, there would be no further interest in merger-mania with billion dollar CEO bailouts. The HMOs would then again become nonprofit and would again compete on an even basis with Kaiser, preserving the worlds finest HMO structure, which would then be the best defense as an alternative to private practice. This would give all Americans a choice for private fee for service or real HMO care. Then with a few tweaks, we would be close to universal health care in a free environment.