Of Course You Don't Like Your HMO

Health and medicine explained.
Oct. 25 1997 3:30 AM

Of Course You Don't Like Your HMO

It's because your employer chose your health plan, and you didn't.

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The most straightforward way to put choices back into families' hands would be to sever the connection between health insurance and work. If health benefits were taxed as income, people would promptly demand that the cash be paid directly to them and that they be allowed to choose their own insurance. Insurers would then have to cater to their needs. Short of that radical change, effective legislation should be passed to increase choices for employees. Some states have established insurance-buying groups that employers can join. These groups give workers a selection of plans and reduce paperwork hassles for employers. Legislation could expand such groups. Some suggest that the law require employers to offer both a managed-care plan and an indemnity plan, as it did in the 1970s when HMOs were first created.

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This week, the president's advisory commission drafting his consumer-protection proposals endorsed a host of patients' rights, including the right to appeal mistreatment by insurers. But employers on the panel scuttled all concrete measures to return choice to consumers. The new rights are nice enough; they'll move consumers a few seats forward on the bus. But employers are still driving, and that's all that counts.

Atul Gawande, M.D., writes a regular column on science and policy for Slate.

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