Can HMOs Be Fixed?

In part one of this essay (“The HMO Revolution: How It Happened, What It Means,” Dissent, Spring 1998) I explored the rapid growth of HMOs, noted potential advantages that prepaid group practices held over traditional fee-for-service arrangements, and considered a number of important shortcomings of HMO/managed-care organizations. I concluded that the greatest difficulty and danger for patients and caregivers lay with the expansion of for-profit health maintenance organizations. Profit is not “incidental” to such entities. It is not something that just “happens” during the course of normal activity, something that those connected with the enterprise are not aware of until the accounting results of the year’s activities are available. Rather, profits are consciously and, sometimes, avidly sought; this quest affects the behavior of everyone connected with the enterprise—physicians, nurses, and all the others who deliver health care services.

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