Sunday, October 2, 2011

If Michael Jackson Had Been Enrolled In An HMO, He'd Still Be Alive

The Disease Management Care Blog has really been trying to not pay attention to the trial of Conrad Murray MD, the infamous propofol-wielding personal physician for pop legend Michael Jackson.  Unfortunately, the whole thing is so lurid, it's difficult to not gawk.

While no one should come to any conclusions about any allegations until all the facts are known, one thing is certain: Mr. Jackson is a poster child for the downsides of having unfettered access to all the health care anyone could ever want.  Dissatisfaction with a first round of plastic surgery and insomnia are common place, but few patients have the resources to go on to decimate their nose and turn their bedroom into an anesthesia suite.

Which brings up a good point.  Regular DMCB readers are well aware of this graph from the Kaiser Family Foundation report on Trends in Health Care Costs and Spending:

Back in the late 1990s, many HMOs made the mistake of controlling costs by aggressively denying payment for anything that didn't meet their definition of "medical necessity."  When it came to costs, it worked quite well.  While that style of managed care has since been defanged, health insurers including HMOs continue to apply a gentler, more transparent, regulated and still evolving standard of only covering treatments that are 1) appropriate and 2) effective when 3) there are no other safer alternatives.

While Mr. Jackson's death is allegedly an example of health care run amok, many mainstream physicians agree that "overtreatment" happens far too often.  Until a better system comes along, classic "1-800-MotherMayI" may have a role to play in keeping other Michael Jacksons from happening. 

The next time the DMCB reads that a "right" to health care should translate into coverage for anything and everything a doctor and patient would want, it'll ask a very simple question:  who's job, then, is it to say no, and if that happens, is it always bad?

No comments: