GREED, GREED, AND MORE GREED

By by Monty Warner

Posted 9:30AM on Monday 17th February 2003 ( 22 years ago )

Over the last decade, HMO's have developed (and through many actions encouraged) a reputation as being highly stingy in their disbursements to doctors and hospitals, and ultimately disinterested in the general health and welfare of their policyholders. That's not exactly a secret in the health care industry - the bottom line can drive the most serious coverage decisions to the clear detriment of the sick and infirmed. However, one HMO in particular has taken this approach to a level unprecedented in its sheer greed and disgraceful lack of concern for patients: WellPoint Health Networks. WellPoint, a California-based HMO and the nation's fourth largest, is currently on a well-funded mission to try to manipulate the FDA into forcing currently-covered prescription drugs to over-the-counter status, saving the company tens of millions of dollars in drug benefit expenses each year. This approach has been targeted at newer non-drowsy allergy drugs (some of which have only been on the market 6 months), whereas these drugs are typically moved over-the-counter status by the drugmaker after years of experience with patients. All this might be fine and good in the abstract to some, but while Wellpoint is working to cheat the system on one end, they're also looking to force their patients to pay higher insurance premiums and deductibles on the other, quietly projecting double-digit premium hikes for consumers over the next few years according to the Los Angeles Business Journal. That's more money to Wellpoint from the people who provide us health care and more money to Wellpoint from us. What do we get in return? A "voluntary" Wellpoint policy allowing (read: subtly encouraging) doctors to permit the practice of "pill-splitting" if patients approve. As a recent article in the Houston Chronicle notes, "because they may suffer from physical, mental or emotional problems, not all patients can correctly split their pills." Picture your 85 year-old grandmother trying to correctly split the drugs she needs to keep her alive. Wellpoint isn't picturing that; all they see is a 21% rise in their profits for the first quarter of last year and, apparently, way too many grandmothers out there. And it doesn't stop there - Wellpoint is expanding this thoughtful approach to a theater near you - recently acquiring markets in Georgia and Missouri and looking to Maryland next -- the plan being to buy up non-profit health care entities and, naturally, quickly turn them into for-profit ventures/schemes. Given the above a case could be made that this expansion fits neatly into WellPoint's slash and burn greed at the expense of its patients, but moving east also raises another question: Why as an HMO would you want to simply hang out in California when your company has had a $50 million RICO (Racketeering) suit filed against you by the California Medical Association? Among the charges against Wellpoint in this suit are the following: "Imposing unfair contract terms, making unnecessary denials and delays of payments;" "using 'coercive, unfair and fraudulent' means to dominate and control doctor-patient relationships for their own financial gain;" and "using market dominance to get hospitals to accept 'take-it-or-leave-it' contracts with non-negotiable terms and some of the lowest rates in the state." These low-rate, take-it-or-leave-it contracts do not help patients; rather, they lower the quality of care patients receive. Driving this train of greed is WellPoint CEO Leonard Schaffer, who before he came to Wellpoint and took on his now-$16.3 million salary was President Carter's Medicare overseer, where one of his notable achievements was convincing Medicaid state officials to reduce the number of days a mother on Medicaid stayed in the hospital after having a baby. Schaeffer, apparently pleased with his deft slash and burn tactics from patients to doctors to across the health care spectrum, recently awarded himself a 29% pay raise from last year. After all, in today's economy an $11 million salary simply isn't what it used to be. Says Jack Lewin, CEO of the California Medical Association: "Doctors feel severe animosity toward [Schaeffer] because he's undermining their efforts to provide good patient care." Patients across the country should take note -and quick. Monty Warner is a former Director of the Center for the Study of Popular Culture.

http://accesswdun.com/article/2003/2/183179