HMO HORROR STORIES: Sometimes Facts Are One-Sided

      A front-page story in yesterday's Washington Post examines the recent phenomenon of using personal anecdotes of tragedy to underscore the need for legislative reform of managed care. According to the Post, such stories "are often more complicated than they seem at first" and many mainstream media accounts do not present both sides' versions of the story, often because of patient confidentiality rights. Barbara Hill, president of Rush Prudential Health Plans, said, "The problem is that medical situations are complicated. They just don't fit into a sound bite." While many managed care problems "are all too real," with half of all respondents in national polls saying they know someone who has had trouble with their HMO, such "horror stories" are often unfairly portrayed, the Post reports.

Barbara Garvey: Worst-Case Scenario?
      The Post uses the story of Barbara Garvey, an anemia patient who died in 1994, to illustrate its point. Her story was used by everyone from President Clinton to the first lady to Rep. Greg Ganske (R-IO) to the major news media to portray managed care plans negatively, saying that Garvey's health plan demanded she fly from Hawaii home to Chicago to receive surgery. She complied, but in a weakened state, she could not be operated on and died days later. What they left out was that Garvey's doctor in Chicago had discovered a potential problem prior to the trip and strongly urged that she get blood tests done before she left, advice which Garvey ignored. The health plan also "dispatched a nurse to Hawaii" to accompany her on the flight. When asked about the HMO's side of the story, Ganske responded, "Those are things I can't make a determination on. ... I go on reports that I read in the press."

Edward R. Murrow Would Be Shocked
      Indeed, the Post reports, the "marketing of personal tragedy has become a cottage industry." Organizations such as Families USA, the American Medical Association, and Consumers for Quality Care all solicit managed care outrages, to be published and/or posted on the Web. "People can understand real-world examples more than they can understand a lot of the rhetoric in this debate," said Lorie Slass of Families USA. But insurance executives "are livid at what they see as one-sided reporting." Mark Merritt, vice president of the American Association of Health Plans, said, "Reporters in any other situation wouldn't run with a one-source, unsubstantiated story from someone they weren't familiar with. Why should the rules be different when it comes to covering managed care, which happens to be under fire politically?" Chip Kahn, incoming president of the American Association of Health Plans, added that the current coverage contains "some of the most biased and crackpot reporting I have seen." One problem is that health plans are often barred from responding to charges due to confidentiality restrictions. Hill said, "A reporter may call with a lot of misinformation, but there's nothing we can do to correct it because the patient won't allow the records to be released."

Administration Feels The Pinch
      George Halvorson, president of HealthPartners, "fired off an angry letter to Clinton" in response to the president's use of an example concerning a breast cancer victim who was insured by the HMO. He wrote: "You owe HealthPartners an apology for the disparaging statements you made about our organization. ... [Y]ou did not bother to verify the validity or truthfulness of the allegations." White House health policy adviser Christopher Jennings said, "We're trying to be a little more careful than we were previously." But, he added, "The very existence of someone complaining about treatment in a health plan is a failure of the health plan." In any case, the tide of managed care horror tales may be abating. John McCarron, an editorial writer for the Chicago Tribune who no longer will use unsubstantiated anecdotes, said, "I think the power of the anecdote, the horror story that we've all heard and become so tired of, is on the way out" (Kurtz, Washington Post, 8/10).