'~ie flf~prnDaily
IighkyFour Years of Editorial Freedom
Edited and managed by students at the University of Michigan
764-0552
Maynard St., Ann Arbor, Mi. 48104
News Phone:
WEDNESDAY, FEBRUARY 27, 1974
upportAdvocates program
THE ADVOCATES PROGRAM is not a
panacea for the problems that
blacks, women, chicano, native Ameri-
can and gay students face as a result of
their oppression. The offices were estab-
lished by the University in order to pla-
cate these students.
However, the Advocacy system has
been surprisingly successful in serving
as a focal point for organizing efforts by
minority students to end discriminatory
practices by the University. For example,
the University's practice of relegating
gay employees to "less sensitive posi-
tions" in the administration has come to
light as a result of the efforts of the Uni-
versity's gay advocates.
The Advocates' Office has proven to be
a thorn in the side of the Administra-
tion since its inception, and this week's
move to "reorganize" the advocacy pro-
gram, which had been brewing for sev-
eral months, is an attempt to water down
the program and make it less visible
without openly killing it.
THE UNIVERSITY BUREAUCRACY has
clearly been dragging its feet on hir-
ing a new Women's Advocate, a position
that has been vacant since Claire Jean-
ette resigned last fall. Eager applicants
have been told by the Personnel Office
that the position is "not open." The Uni-
versity Administration must stop equivo-
cating, and begin an active search for a
suitable Women's Advocate.
For many students, the Advocates pro-
gram-was the only part of the University
hierarchy which responded realistically
to their needs. The advocates serve an
important function in our college lives.
Therefore, we must actively oppose any
attempt to make them less visible, ac-
cessible, or* powerful. Call Henry John-
son's office and voice your disapproval
of the proposed revisions in the Advo-
cacy program.
-MARNIE HEYN
Editorial Director
Hos
By THE MEDICAL COMMITTEE
FOR HUMAN RIGHTS
LOGICALLY speaking, one would
expect the serf-proclaimed
Community Medicine Division of
U-Hospital to be concerned with
providing adequate, reasonably in-
expensive, accessible medical care
to the Ann Arbor Community.
It isn't.
Under the leadership of Dr. Ro-
bert Carpenter, the "Community"
Medicine Division is now in the
process of setting up a pre-paid
group health plan known as a
Health Maintenance Organization
(HMO) to be christened the "Uni-
versity Health Plan."
The very name "University
Health Plan" underscores the
"community" which Dr. Carpenter
intends to serve: primarily the pri-
vileged, upper mhiddle class, Uni-
versity, research, and business
community, people who already
have health insurance through Blue
Cross.
"It is clear that HMO's
are not Health Main-
t e n a n c e Organiza-
tions, but profit main-
tenance organizations
for the forces which
already control the
quality and distribu-
tion of health care in
this country."
The urgent. medical needs of the
rest of us, the large community
of low income people who are too
"rich" to qualify for Medicaid (the
maximum income allowed for a
family of four to qualify for Medi-
caid is $295 per month, or $3540
per year), but who cannot afford
either Blue Cross or commercial
health insurance, are not recogniz-
ed by the "Community" Medicine
Division.
ACCORDING TO A spokesperson
for the "Community" Medicine Di-
vision, the University Health Plan
will give health consumers a
"choice:" either Blue Cross or
the new HMO. However, a signi-
ficant sector of this community and
Washtenaw County cannot afford
either plan. And, with St. Joseph
Mercy Hospital moving out of Ann
Arbor to Superior Township, health
services for these people will de-
teriorate to a frightening low level.
'S -1
pita proposes
Benefits Office has never heard of pany's income, and passing off all
University Health Plan. the risk of inflation to the HMO.
IN MOST HMO's, the doctors, If fees outstrip income from prem-
nurses, and other supportive per- iums, it's the HMO's hassie.
sonnel work for the HMO on sal- HMO's, in other words, shift the
ary, seeing only HMO patients. Ad- risk of medical inflation off the
vocates of the HMO idea rhaoso- shoulders of the Government and
dize how this system is a return to the health insurance industry.
the Good Old Days of the family That's the real reason why these
doctor who knows you personally groups are so eager for HMO's
and is responsible for your health to get going.
care. There is some truth in MEDICAL CARE IN AN HMO
this. The chances of seeing the AN OBVIOUS question is: what
same doctor regularly are greater is health care like under an HMO?
in an HMO than they are under Under one California HMO, en-
Blue Cross. Furthermore, HMO's rollees paid 22 per cent less than
guarantee that contracted services they would have under Blue Cross,
will be available to subscribers, and received 9 per cent m o . e
whereas under Blue Cross, services services. The additional services
may be insured, but you have to provided by HMO's usually consist
find them yourself. of yearly physicals and immuniza-
On the other hand, enrollees are tion shots, services which are vir-
"locked into" their HMO. If they tually impossible to have covered
see a physician outside the HMO, under Blue Cross. The commercial.
they must pay the entire cost them- health insurance industry has nev-
selves. This differs fromi the Blue .,:":v:.;" :"":".",:fr ." .
Cross system where insured serv-
ices are covered no matter where
you get the care. In other words,
Blue Cross would nay for away-
from-homehospitalization; an MO
wo"ld not.
THE BIGGEST selling point For
HMO's is their "efficiency." Ad-
vocates of HMO's claim they con-
trol skyrocketing medical care in-
flation, eliminate waste, and de-
crease hospitalization bills, the
single most significant factor in
health care costs today.
But, like the all-you-can-eat-spec-
ial, where the restaurant knows
it will realize a profit by setting
the price well above what the
"average" person will consume,
HMO's are being pushed by forces
with specific economic gains in
mind.
WHO WANTS HMO's?
President Nixon. The commer-
cial health insurance industry. The
major corporations. Blue Cross/
Blue Shield.
The soaring costs of medical care
have hurt everybody, including the
Big Money. The Government by
law must sustain an increasingly
voracious and uncontrollable Med-
icare/Medicaid monster which is "Cost-conscious HMO's
draining a larger proportion of the
Federal Budget each year. Health bug detoxification and
insurance industry profits h a v e home care, and dental c
also been eroded by inflation.
THE POWERFUL forces in Gov- m::.......,
ernment and the insurance indus- er been interested in sorely need-
try which today literally control ed preventative medicine.
our nation's medical care delivery But, if there is "more" care in
have decided that something must an HMO, how could it be cheaper?
be done to control runaway hesith First of all, we disagree that the
costs. The Government is eager HMO here would be any cheaper.
to clamp a lid on spiralling Medi- Even allowing that some 14MO's
care/Medicaid spending. The health are indeed cheaper than B I u e
insurance industry wants someone Cross, how do they deliver more
else to bear the expensive risk care?
ill-health lan
move into established health facil- Since the University of'Michigan is
ities. a publically supported facili'y, the
If Kaiser enrollees are dissatis- public has a right to kn-w how
fied with their pre-paid health plan, the "Community" Medicine h a s
they're stuck. They are only Cov- been spending our money, Most
ered for care at Kaiser. Still, many HMO's cost between $1-3 midlion
Kaiser enrollees choose to pay out to set up. MCHR feels this money
of their own pockets for 'care that could be much more usefully spent
would normally be free at Kaiser. serving the needs of patients who
Studies done by Kaiser itself mdi- presently have no health insurance.
cate that 45 per cent of its enrol- For example, $1 million is enough
lees have paid for medical services to set up two or there com runity
outside the Kaiser Plan. clinics in areas of this community
HIDDEN COSTS OF HMO's that are far removed from tne hos-
Despite the tantalizing promise pitals.
of "free" health care in an HMO,
most HMO's (including University "COMMUNITY" Medicine offic-
Health Plan) have what are known ials say this much about their
as "co-payments" and "deducti- lHMO: enrollment will be open to
bles." These are out-of-pocket fees all who can afford it, and 10 per
that enrollees must pay in addi- cent of the enrollees will be Medi-
tion to their premiums before cav- caid people. Blue Cross will handle
erage begins. Dr. Carpenter even all fee collection and bookkeeping,
admits that Kaiser covered only and will rake S per cent off the
43 per cent of enrollee health care top for this service. The docir-
"LY:.-..Y.JTf.. M ."" J.M J:A J , J.
Nixon's speech: Incredible'
F ANYONE NEEDED proof that Richard
Nixon doesn't live on the same planet
as the rest of us, any doubts on -that;
score should have- been dispelled by the
President's incredible performance in his
televised news conference last night.
Of course, it was no surprise that the.
Chief Executive would appropriate a few
minutes of prime time to peddle his*
opinion that he has to be guilty of a
criminal offense in order to be im-;
peached.
It was equally characteristic that he
would call the Constitution's definition
of impeachment "very precise" whene
two centuries of American precedent -
as well as the vicissitudes of the Eng-
lish legal system in defining the:catch-
all phrase "high crimes and misdemean-
ors" --- shows clearly enough that pre-
cision and impeachment have -almost
nothing to do with one another.
THE MAN'S UP against the wall, and
self-serving maniptilations of the
truth are to be expected when impeach-
ment talk pops up.
What's even more incredible are the
President's perceptions of and reactions>
to the problems which don't have a bear-
ing on his continued tenure in office . .
but which probably mean a lot more to
the everyday lives of most of us.
The Administration's handling of the
energy crisis, for example, has been in-
coherent and confused, to put it mildly..
TODAY'S STAFF:
News:.Barbara Cornell, Jeff Day, J u d y
Ruskin, Steve Selbst, Sue Stephenson,
Becky Warner
Editorial Page: Brian"Colgan, Paul Has-.
kins, Marnie Heyn, Alan Kettler, Sue
Wilhelm
Arts Page: Ken Fink, Jeff Sorenson.
Photo Technician: Ken Fink
While the public gets treated with a
Technicolor version of "Simon Says," the
Federal Energy Office and the Office of
Management and Budget are issuing
conflicting figures with respect to future
gasoline shortages, nobody knows for sure
the degree to which the Arab Oil Embar-
go has proved effective, the role of the
international oil companies in creating
and manipulating the "crisis" to their
own benefit has hardly been explored,
and the President has the gall to claim
that the worst is over because his loyal
aides are treating energy "as a prob-
lem, not a crisis."
IT'S HARD-NOSED businesslike prac-
tices. like this which made Warren
G.. Harding what he is today. If any-
thing has become perfectly clear in the
last, twelve months, it's that Richard
-Nixon is the kind of administrator who
could bankrupt a chicken farm during
an egg shortage.
The :litany of Mr. Nixon's managerial
incompetances is awe - inspiring, espe-
cially if one accepts his declarations of
personal innocence in the Watergate
nonsense. The man delegates authority
to bunglers, he hasn't set up an informa-
tion .system allowing him to monitor the
activities of his subordinates and inter-
vene when things go wrong, he relies on
a handful of. people who share his biases
to decide what he needs to know, and
he cannot - or will not - tolerate non-
unanimity within the White House
staff..
FRANKLIN D. ROOSEVELT proved that
you don't have to be a superb ad-
ministrator to get things done. Nixon's
claim of expertise in an area where he
is .manifestly incompetent, is just one
more piece of evidence that shows a con-j
sistent denial of reality which has made
his incumbency a supreme disaster.
-CLARKE COGSDILL
do not provide for public health needs such as:
alcoholism treatment, nutrition programs, day care,
rare."
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HMO's operate with a fixed
amount of money to spend on
health care. They must control
costs by controlling the kind and
amount of services available. The
best way to do this, of course, is
to keep the patients away from the
services.
"The fewer and cheaper t h e
services that an HMO provides,
the more money it can keep for it-
self for profits (because a o m e
HMO's are stockholder owned), for
expansion, and investments. As
the journal "Hospital" pointed out
in a special issue devoted to
HMO's: 'When profit is made by
decreasing demand for treatment,
the consumer's health is in even
greater danger than it is under
the present system.' "
BILLIONS FOR BANDAIDS
THERE IS a great deal of evi-
dence to suggest that under a
Blue Cross system, there is un-
necessary treatment, surgery, and
hospitalizatiodi. Since the cost of
care is covered by insurance, doc-
tors are tacitly encouraged to run
up huge bills because either Biue
Cross or the Government pays for
it anyway.
Under an lIMO, which must de-
creasehospitalization costs to make
ends meet, patients can look for-
ward to incomplete hospital care
and testing, and possibly dismiasal
before they are really ready. Not
that doctors will consciously inder-
treat in an H1MO; rather, 'h-- HMO
will be administered in such a way
as to make under-treatment normal
procedure, as opposed to B 1 u e
Cross where the doctor has the lee-
way to be more thorough. Tests
which are medically optional, but
covered under Blue Cross, will
simple not be covered under
HMO's.
AN HMO AT WORK:
THE KAISER PLAN
THE KAISER Health Plan in
California is touted by the Nixon
Administration and by the "Com-
munity" Medicine Division as a
model of HMO "efficiency." In
1969, it cleared a healthy $3 xmil-
lion in profits.
What is care like at Kaiser?
Three to four hour waits are not
uncommon. Next to hospitaliza-
tion, personnel costs account for a
large share of health care bills.
The soaring cost of medical care
is due in part to the fact that
only in the last five years have
non-professional health workers
even begun to earn a living wage.
So: the fewer the staff, the I e s s
money is paid out in salaries. The
Kaiser ratio of doctors to patients
is 1-935. The national average is
1-750. (Billions for Bandaids). The
University Health Plan will main-
tain a ratio of 1-1000!
costs, leaving the members to
scrape up the remaining 57 per
cent. The University Health Plan
munity" Medicine Division admin-
will have co-payments, but "com-
istrators say they "do aot yet
row' how much these c-targes
will cost enrollees.
WHERE THE PROFIT IS
WHICH GROUP of people are
most profitable to cover? The peo-
ple who need the least health care,
namely: the wealthy and the young.
Low income, poor people, and the
elderly tend to use more medical
services thanthe well-off who have
had decent health care all their liv-
es. Luckily for- the University
Health Plan, the high premiums
will automatically screen out most
low income and elderly peop16
The HEW, in return for millions
"At Kaiser, physicians are allotted 15 minutes to
perform a 'complete' exam. The pressure on staff
is enormous, and the quality of care suffers. This
is the reality of H O advocates' promises of that
'good old family doctor'."
vv::::m: v a , ": h :vray:w"..v4:'r ?" 'iv"'":"?im l:S i:y""::}fY.:}?.:}N : %? :"'ea ?,:{t;;.;?r " "??p;.
"But, like the all-you-can-eat-special, where the
restaurant knows it will reaize a profit by setting
the price well above what the 'average' person
will consume, and by eliminating menu variety,
and decreasing the number of chefs, HMO's are
being pushed by forces
gains in mind."
patient ratio will be 1-1000 which
will guarantee long waits, short
exams, patient dissatisfaction, and
pressured, irritable doctors a n d
staff. The U-Hospital North O u t-
patient Building, will be us.0 for
out-patient care. In-patients w i ll
stay in U-Hospital, but probably
not for very long. Hospital-.ation
coverage will match the Univer-
sit 's Blue Cross group policy cov-
erage. There will he evening ow -
patient clinic hours (which is one
welcome improvement over U-Hos-
pital's 9-5 General Medicine Cln-
ic hours.)
CONCLUSION: ACTION!
It is clear that HMO's are not
Health Maintenance Organizations,
but profit maintenance organiza-
tions for the forces which already
with specific economic
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WHAT IS AN HMO?
An HMO is to health care whit
an all-you-can-eat-special is to a
restaurant. It is an arrangement
where a limited number of "en-
rollees" pay a fixed amount per
month for a specified range of in-
and out-patient services, regard-
less of how much or how little
service is used by the individual
enrollee. HMO's generally cost be-
tween $30-$60 per month for a fam-
ily of four. Although the "Commun-
ity" Medicine Division has not re-
leased its rate scale yet, a spokes-
person estimated that a family of
four would pay "around $50 p e r
month." Currently, comparable
coverage under the University's
group Blue Cross policy cost a
family of four $49.04 of which the
University subsidizes $36.00, leav-
inz the staff family with a month-
of medical inflation while at the
same time guaranteeing its own
healthy profits. For these groups,
HMO's are just what the doctor
ordered.
Under the present fee-far service
system, neither the :;overnment
nor the health insurance industry
has any control over how much
money they must shell out for di-
rect medical care. Bills are simply
sent to the Federal Government
under Medicare/Medicaid, or to
the health insurance company or
Blue Cross, if the patient is in-
sured. .
IN THE case of *he insured
patient, if the price of health care
rises,' the increase is passed along
to either the Government or the
health insurance industry. T h e
Big Money loses profits, raises rat-
e tonmnensate and incurs th
in HMO seed money, is requiring
that a certain proportion of HMO
enrolees be MedicaW/Medicaid.
people. This way the Government,
which wants out of the health care
inflation spiral, can pay a fixed
amount per year to HMO's f o r
Medicare/Medicaid patients instead
of guaranteeing more blanket cov-
erage undertthe old system. Uni-
versity Health Plan, though ni o t
funded by HEW, wants to be 10
per cent (2000 out of 20,000) Medi-
caid people. .
THIS ARRANGEMENT is no
bargain for the poor. Under Medi-
caid, a wide range of services are
available absolutely free. In the
HMO, however, the Government
will pay the enrollment fee and
leave all the co-payments to the
individual patient. Then the ques-
tion becomes: will the Government'
give Medicaid recipients the
"choice" of enrolling in an HMO
or being droped from Medicaid al-
together? At this point, no o n e
knows.
F u r t h e rmore, cost-conscious
HMO's do not provide for public
health needs such as: drug de-
toxification and alcoholism treat-
ment, nutrition programs, day
care, home care, and dental care.
THE UNIVERSITY-HEALTH
PLAN: CARPENTER'S CAPER
STILL, Dr. Carpenter's "C o m -
munity" Medicine Division is
grinding ahead with it's University
Health Plan. Enrollment is n o w
scheduled to begin in late 1974
or early 1975.
The "Community" Medicine Di-
control the quality and distribu-
tion of health care in this country.
The differences between an 1HMO
and Blue Cross are comparable to
those between a Buick and a Pon-
tiac: they look a little different,
but sale of either car profits Gen-
eral Motors.
The "choice" comes down to
impersonal, rushed, inadequate and
expensive care through Blue Cross,
or the same, possibly worse, under
the HMO - and still, only for
those who can afford it,
WHAT ABOUT the rest of us?
What "choice" do we have? Both
Blue Cross and the University
Health Plan are too expensive. The
"Community" Medicine Division
is not serving this community's or
any community's needs by setting
up this HIMO.
MCHR suggests two courses of
action: As individuals, people con-
cerned about the future of health
care can call the "Community"
Medicine Division and question the
idea of the University Health Plan.
Harrassment of this kind could con-
ceivably communicate to Dr. Car-
penter that he is being carefully
scrutinized by people who ques-
tion his programs and priorities. It
also might embarrass the "Com-
munity" Medicine Oivision into re-
leasing information like where it's
money is coming from. The phone
number is: 764-5384.
To whatever extent individual
harrassment may disrupt business
as usual, it probably will not alter
Dr. Carpenter's priorities or direc-
tion. Only organized mass action