HMO's at 15% Approval

Apparently, HMO's only have a 15% approval rate with Americans.  People don't like the waits, and the institutional service, but, more than anything, they don't like someone in the HMO back office rationing their care based on pre-set formulas about what care or test is appropriate in each given situation.

All well and good.  However, if this is so, then why does the idea of universal government health care appeal to so many people?  Because if universal health care turns out as well as it possibly could, then the best we could expect is that it will resemble... current HMO's.  And unfortunately, it will probably be worse.  Because today, the guy in the HMO back office who is setting up the allowed care formulas knows that if he cuts things back too far, you will go to another competitor.  No such threat or incentive will exist for the government bureaucrat, who will be setting the formulas based on stupid mindless rules and interst-group pressures and absolutely no concern about your satisfaction.

  • workisglory

    What are the approval ratings like in countries with universal government healthcare?

  • http://www.steamstreet.com Jon Nichols

    When asked to rate _their own_ health coverage, Americans are overwhelmingly positive, with 79% rating it as excellent or good. Even poor families have a 66% positive rating of healthcare. But ask them about the overall state of healthcare coverage in the US, and only 25% believe that it's good or excellent.

    I suspect that HMOs have the same problem... people are pretty happy with their own HMO, but they have this suspicion that people all being denied coverage all over the place. It also reminds me of some surveys of pollution... in almost all cases, people believe that the area that they live outputs less pollution then everyone else. They look around and see a fairly clean environment, and assume that everywhere else must be terrible (because that's what they see on the news).

    The upshot of this is that it's probably unlikely that any large change in the healthcare system will emerge. As soon as American's look at the details of these plans, they'll compare them against what they have now, and since they're generally satisfied, they won't want the change. This _could_ be a good thing, as it might result in some smaller, but just as important changes (like those to make individual policies have the same tax treatment as company policies).

    http://news.aol.com/gallup/story/_a/americans-have-mixed-views-of-healthcare/20061121130409990002

  • tribal elder

    I was fortunate with HMO experience 20+ years ago, and I've figured out why mine worked, and can guess at why most don't. Our favorable experience was with a 'clinic' type HMO.

    When we selected the HMO, we selected the facility at the teaching hospital as our home clinic. It was a drive. It cost to park.
    BUT, the docs were the docs were the faculty at the afiliated, on-site medical school. As a result, they were
    1) Guys who were financially okay, who probably didn't NEED to see patients, but they liked practicing medicine. This allowed them to practice without all the 'business' headaches of who's paying the light bill, hiring the receptionist, ...
    2) Because they were near-deities in the hospital hierarchy, they weren't pushed around by the paper shufflers and indecision-makers.

    Their reasons for HMO affiliation were in concert with the customer/patient/insured's needs.

    At a doc who signs his office onto the HMO network, you've probably got a guy who has extra patient capacity. Retail patients (but nobody pays retail in medicine-illusory pricing is another topic) can't keep his waiting room full enough to pay his student loans. He signs on for a per-head rate; his financial incentive is to delay/defer/discourage referring you outside his office. Got something acute and deadly ? In this situation, you are potentially in trouble-the full waiting room at his office means long waits and perhaps, given overconsumption of underpriced (to the patient) care, a certain fatigue on the doc's part in crisis identification.

  • http://www.albin.net/ John Wilkins

    “Because today, the guy in the HMO back office who is setting up the allowed care formulas knows that if he cuts things back too far, you will go to another competitor.”

    This is not true. If you try to go to a competitor, they will claim you have a pre-exisitng condition. So the back office knows you are stuck with them.

    If you have a life-threatening condition and your claim is denied, new insurance won’t help you. That's why universal health care will be MUCH better than HMOs.

    And as for “setting the formulas based on stupid mindless rules and interst-group pressures and absolutely no concern about your satisfaction.” You mean like HMOs do now for their stock holders? Besides the health insurance companies and their for-profit interests, what interest group are you referring to that would want to limit health care?

  • markm

    “Because today, the guy in the HMO back office who is setting up the allowed care formulas knows that if he cuts things back too far, you will go to another competitor.”

    For most people it's their employer who picked the HMO, not the individuals. That's not necessarily a bad thing - a large corporate HR department could take into account the good or bad experiences of many employees who needed expensive treatments in selecting an HMO - but I suspect that just as often they make the selection on price alone. Result, service as bad as the law allows. That's still better than the UK and Canadian systems, where you only get service as good as the budget appropriations allow, but other countries have had better experiences with partially socialized medicine...

  • http://www.wackedecon.com Murray Mises

    This same point can be made about Homeowner Associations (HOA). Peple never have anything good to say about their HOAs. They complain about power-hunger, petty individuals taking control of the board and imposing their will on everyone else. Well… that is what happens in government, but on a much larger scale. At least with HOAs you are dealing with neighbors you see every day.

  • Methinks

    "If you try to go to a competitor, they will claim you have a pre-exisitng condition."

    Really? Never happened to me or anyone I know and I've switched a dozen times in the past ten years. What percentage of the population truly has a pre-existing condition that prevents them from switching insurance providers? How big is the problem really? I suspect you're overstating.

    What evidence do you have for your assertion that universal healthcare (i.e. socialized medicine) will be better? In my experience, socialized medicine is infinitely worse. The quantity and quality of supply is substandard and you have to pay a large sum out of pocket to get anything that resembles standard care in the United States private healthcare system.

  • Methinks

    "That's still better than the UK and Canadian systems, where you only get service as good as the budget appropriations allow, but other countries have had better experiences with partially socialized medicine..."

    True. However, most of those better experiences have been in countries with miniscule and rather homogeneous populations. Countries with large and diverse populations have had much worse experiences with socialized medicine - notably the Soviet Union.