One Problem with the HMO Industry

One problem with the health insurance industry (among many) is the fact that what costs them a little money may actually save society a great deal of money, but what does an HMO care about beyond its bottom line?

Take today's Globe story on the state's expansion of required mental health coverage, for example. The general consensus is the new law will add a little less than 1% to the costs of health care in the state -- but in return, for example, drug addicts will be able to get necessary treatment of their diseases. Over 15 million people are addicted to alcohol in America alone - translating to around 5% of the population. In Massachusetts, that's over 300,000 people.

Imagine their economic impact on this state if they received treatment that could help them cope with their disease? Whereas it doesn't make economic sense for Blue Cross to pay for all the treatment necessary to help someone get off the drug, or get over their depression, etc., it would make perfect economic sense for the federal government to pay for it under a health plan. Those people could return to work and start participating in the economy beyond the shadows.

Treating patients with mental health disorders or diseases is a huge net plus for society, but will never be so for HMOs. They'll continue to resist it, as they will even under the new policy.

There remains one piece of unfinished business. When the state last attempted to overhaul mental health services nine years ago, regulators left untouched the broad range of treatment that falls somewhere between overnight hospital stays and trips to the psychiatrist. That includes such services as residential treatment programs, home-based care, and day treatment programs. In that void, advocates say, patients have often had to battle, frequently failing, to get needed help.

“People with mental illness often have more difficulty navigating the speed bumps that health plans put in place,’’ said Dr. Gregory Harris, a Brookline psychiatrist and chairman of the managed-care committee of the Massachusetts Psychiatric Society.

It's going to take a firm stand to make sure the HMOs don't screw us over in the long run, but why should we have to do it? The sooner we can get a public option and/or single payer, the better, because then we can start to decide health care based not on the bottom line, but on what's best for doctors, patients and society.