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Read Making a Killing

home / healthcare / in the media

Jun 28, 1999

Merger Hurts Patients

Opinion Editorial by Jamie Court
The Justice Department's approval last week of the Aetna-Prudential merger shows that Justice is indeed blind.

The new Aetna will provide health care for one in every 11 Americans and will have the bulk to downsize services, hike prices and leverage doctors into accepting unreasonable contract provisions and reimbursement rates. In some markets, the HMO will cover more than 50% of patients, and neither doctors nor patients will have the power to vote with their feet.

Eighteen of the largest HMOs and managed care companies a few years ago have been reduced to seven titans: Aetna, Cigna, United HealthCare, Foundation Health Systems, PacifiCare, WellPoint Health and Kaiser.

Could there be any greater symptom of HMO collusion than when the Big Seven decided virtually on the same day last year to dump rural seniors in Medicare if they could not leverage the federal government into paying more? Wasn't it an early warning sign when, months before, they cut back in unison on the prescription-drug benefit and no-co-pay policy that enticed seniors into Medicare HMOs in the first place?

Was it really coincidence that every one of them uniformly has hiked premiums for all of their patients substantially this year?

This HMO monopoly will result in a further downsizing of the nation's standard of care based on business, not medical, ethics. Bully Aetna is the avant-garde.

The American Medical Association reports that Aetna's contract requires doctors to provide the "least costly" alternative, which may not be the best medicine according to physicians' judgments and gives Aetna unilateral power to deny treatment. Thousands of doctors already have defected from Aetna because reimbursements do not allow them to provide high-quality care. Still, the Justice Department has refused to move against Aetna's "all-or-nothing" contract, which requires physicians who accept one Aetna patient to treat all Aetna patients under every Aetna plan.

We can only hope the courts and Congress do more to protect against HMO consolidation than the Clinton administration, whose patients-rights platform is missing a critical plank.

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