P. J. O’Rourke, author of Give War a Chance and Parliament of Whores (concerning the US Congress) states, “If you think health care is expensive now, just wait until it’s free.” Congressman Vic Fazio during his election campaign in our Carmichael neighborhood, said that the issue will only be subject to window dressing in 1995. He couldn’t predict what might happen in 1996.

Robert S. Eliot, M.D., Chairman/Director, Institute of Stress Medicine International in Colorado states that 72% of what happens to us in health and in illness is within our control… Maybe we should just start working on that part we all can control.

Just how fluid the cost of care is was exemplified by a cardiologist noting that his patient’s cholesterol was in the high normal range. He pointed out that some researchers presented data that would justify nearly half of the population taking lipid reducing drugs since the lower the level the better. But having an extra hundred million adults taking a drug that costs about a $1000 per year would add a hundred billion dollars to health care costs. There must be dozens of other similar instances. To keep health care costs to a trillion dollars per year reflects a lot of restraint on behalf of all physicians. How government reduces the level of care is exemplified by the MediCal program which continues to restrict such basic drugs such as H1, H2, Ca Channel, and Beta blockers. And to think that the state almost became one giant MediCal program. But the sad part is that not only would the level of care have decreased, the costs would have increased as with any government program.

The WSJ Headline by staff writer George Anders: The next Get-Rich-Quick Idea: Starting HMOs in New Markets. Last year 29 new HMOs were formed–more than double the 1992 rate. This year HMOs are being started at the rate of almost one a week. Bob Atlas, a consultant of Lewin-VHI Inc. in Fairfax, VA., says “There’s pretty good money to be made by owning an HMO.” Start up costs can be as low as $2 million in small markets. Many HMOs turn profitable within 2 1/2 years, and some HMOs with fewer than 30,000 members have been sold lately at prices exceeding $1500 per member…That’s a $45 million return on a $2 million investment plus 2 1/2 years work. Not bad for an investor. But sad that over a half year of 30,000 members’ premium just went for profit! Isn’t that rather like trading stocks on our patient’s health?

Arthur M. Louis, staff writer for the SF Chronicle reported that Foundation Health Corp of Rancho Cordova purchased Intergroup Healthcare Corp, (in Arizona) and its majority shareholder, Thomas-Davis Medical Centers, for $720 million. This adds 382,000 subscribers. That appears to exceed the WSJ estimate of $1500 per member. Which is also more than I pay in a full year for the FHP premium on my employee.

The Friday noon conference at MSJ by FHP stated that this acquisition move was necessary should the California single payer initiative pass and their California business evaporate. I guess they’re breathing better now that the elections are over.

Several of my patients recently stated that an HMO representative visited their homes trying to sign them up for their insurance plan and to also change doctors to one of their physicians. Wasn’t patient stealing considered unethical, or at least bad form in private practice when we all got along consulting with each other?

The quarterly Sutter medical staff meetings have really been one of the best in the community. Not only were the speakers more renowned, it was always a treat to see Patrick Hayes perform while giving his report. He was so clear and insightful in his thinking. Once while he and I were walking down the buffet line together after a meeting, and American River Hospital was on the block, I asked him why he didn’t buy AR? He immediately listed five reasons why it was such a bad buy. As I recall, he stated it was overpriced; it would take $10 million just to bring it up to community standards; the facilities would eventually have to be rebuilt; the surrounding community was hostile and would fight such an effort all the way; and it would probably cause an antitrust problem. Scott Ideson at the MGH Townhall meeting essentially confirmed Pat was right when he stated that Mercy Healthcare Sacramento had 1158 beds and would have to reduce that to 600 beds by 1997. ARH would be the first to “go.” We were saddened to hear of Pat’s resignation. We wish him well.

Francis A. Davis, MD, bade us farewell after 25 years of publishing Private Practice, working together for excellence in medical care. His final editorial included five parting comments. To doctors: You have failed your patients by letting third parties make their medical decisions. To medical organizations: You should be supporting programs that put the patient and doctor back in charge of the patient’s medical care. To pharmacists: The freedom you thought you would gain by having the authority to substitute what is written on the prescription eventually allowed prescriptions to be filled out of state where the writer of a prescription doesn’t even have a license to write prescriptions. To hospitals: You should get out of the practice of medicine and limit your work to hospital care for the sick patients. To the research pharmaceutical companies: Spend your public relations money at the grassroots level to educate both doctors and patients because medical research is the key to quality medical care. He then ends by adding to an old quotation: “I am sorry that I only have one life and one fortune to give to my medical profession and country.”

Have a Happy Holiday Season and a Professionally Pleasant Practice in 1995.