What's Wrong With Managed Care

"Give Medicare a strong dose of managed care" (News: Analysis & Commentary, Feb. 27) and "Managed care beats Medicare any day" (Editorials, Feb. 27) both fail to mention many of managed care's pitfalls. If more and more of the elderly are forced into health-maintenance organizations, the HMOs will have to find another way to hold down costs, and that will be by rationing care.

Dr. Stephen C. Cohen

President, Physicians Who Care

San Antonio

Mike McNamee, writing on Medicare and its problems, would do well to read BUSINESS WEEK. Your issue of June 27, 1994, had a long story on the woes of FHP International Corp. and other HMOs ("At an HMO giant, critical questions," The Corporation). It included a section on studies by the Center for Health Policy Research, finding that seniors who depended on Medicare received home care superior to those using an HMO.

Many of us stay out of HMOs because we are skeptical about the claims of managed care. Denial of care is one good way to cut the cost of care.

Leslie N. Landes

Rye, N.Y.

As a Medicare recipient, I should state that Medicare is handled by intelligent representatives who deal with retirees and the disabled in a helpful and caring system. In my experience, we are not treated so well by managed-care firms or their employees.

Santa M. Shane

New York

The cheers for managed competition present only part of the story. Health- care costs for business went down for a variety of reasons in 1994, including managed competition, cost-shifting to employees through higher co-payments and deductibles, and a continuing decline in the number of employees covered by their employers.

In my inner-city family practice, I regularly see uninsured long-term employees of major corporations who are kept at part-time to avoid benefit expenses. Over the past five years, the proportion of Americans with private employer-based insurance has dropped one percentage point a year, to only 57% in 1993.

Dr. Kenneth B. Frisof

MetroHealth Clement Center for Family Care


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