Ian Richie
Report from the NYTimes 7/14/99 Report Says Profit-Making Health Plans Damage Care July 14, 1999 Related Articles Issue in Depth: Health Care Forum Join a Discussion on Health Care Reform By SHERYL GAY STOLBERG WASHINGTON -- Patients enrolled in profit-making health insurance plans are significantly less likely to receive the basics of good medical care -- including childhood immunizations, routine mammograms, pap smears, prenatal care, and lifesaving drugs after a heart attack -- than those in not-for-profit plans, says a new study that concludes that the free market is "compromising the quality of care." The research, conducted by a team from Harvard University and Public Citizen, an advocacy group in Washington, is the first comprehensive comparison of investor-owned and nonprofit plans. The authors found that on every one of 14 quality-of-care indicators, the for-profits scored worse. But because the researchers favor national health insurance, some questioned their findings. "The market is destroying our health care system," Dr. David U. Himmelstein, associate professor of medicine at Harvard University Medical School and the study's lead author, said in a telephone interview. "We have had a decade or more of policies aimed at making health care a business, and they have failed." Investor-owned health plans, which are typically made up of loose networks of doctors, have come to dominate the American medical landscape in recent years. These plans, offered by companies like Aetna, U.S. Healthcare and Cigna Healthcare, last year covered 62 percent of all patients in HMOs, as compared to 26 percent in 1985. Yet most research on quality of care in HMOs has focused on traditional nonprofits, among them Kaiser Permanente, in California, and HIP, based in New York. The new study, which appears this week in the Journal of the American Medical Association, analyzed quality-of-care data from 248 investor-owned and 81 not-for-profit plans in 45 states and the District of Columbia. These plans provided coverage to 56 percent of all Americans enrolled in HMOs in 1996, the year from which the patient information was drawn. Among the findings: In profit-making HMOs just 63.9 percent of 2-year-olds were fully immunized, as compared to 72.3 percent in nonprofits. Lifesaving beta-blocker drugs were given to 59.2 percent of heart attack patients in for-profit plans, but 70.6 percent of patients in nonprofits got the drugs. Diabetes patients were less likely to receive annual eye exams to prevent blindness in profit-making plans; the figure was 35.1 percent, as against 47.9 percent in nonprofits. The investor-owned plans fared worse, the authors said, even when all other factors, like location of the plan, and whether the doctors were employees or members of networks, were taken into account. While the study had certain limitations -- it did not examine patient outcomes, for instance -- the authors, who paid for the research themselves, said the data were the best available. The study is being published just as the Senate is embroiled in a divisive debate over how to protect patients' rights and regulate HMOs. While the authors say the timing is coincidental, the work is already influencing the discussion. In a statement released Tuesday, Sen. Edward M. Kennedy, D-Mass., who is pushing for HMO regulation, said the research "contains strong new support for HMO reform." But representatives of the insurance industry, which opposes regulation, argue just the opposite. They say the study demonstrates that, even at their worst, health maintenance organizations provide better care to patients than fee-for-service arrangements that were common 10 years ago. "The best conclusion that can be drawn from this study is that managed care is improving the quality of health care for those Americans that are covered by health plans," said Susan Pisano, a spokeswoman for the American Association of Health Plans, which represents both for-profit and nonprofit plans. Ms. Pisano also accused the authors of confusing "analysis and ideology." Himmelstein did not dispute that he has a bias. "My bias is that for-profit HMOs kill people," he said. But Eli Ginzberg, a health care
Ian Richie 2.
Objective history, that grand imagined jewel of the Western literary world was given a lesson in Oklahoma last month when the Thunderbeings sent 78 tornados to remind we informationed folks that new is "great." That only the mountains last forever and that the development of individual and community knowledge is the only possible real meaning of life. I asked my Aunt about Morris, the little town where my grandparents are buried and where 98% of the town was lost to the thunderers a few years back. She said, its sooo beautiful.Everything is new now. But will America be comfortable when everything is lost. What will be the carrier of the knowledge now that the songs are banal and the singers are so fragile? REH TECHNOLOGY History: We're Losing It They told us digital data would last forever. They lied. How do we save the past before it all disappears? By Arlyn Tobias Gajilan First-time parents Michele and Steve Brigham of New York can't imagine life without their 6-year-old daughter, Courtney or the family camcorder and camera. Like millions of other parents, the Brighams have videotaped and photographed their daughter's first breaths, first steps, first birthday and dozens of other events in a rapidly growing library of more than 1,800 minutes of videotape and 3,000 photographs. "It may seem excessive," admits Michele. "But I think Courtney will appreciate it all when she grows up." Unfortunately, she might have nothing to look at. By the time Courtney turns 30, sunlight may have faded most of her color childhood photos, and in the off chance that the tiny VHS-C videotapes featuring her many firsts survive decades of heat and humidity, there probably won't be a machine to play them back on. Home videos and snapshots aren't all that are at risk. Librarians and archivists warn we're losing vast amounts of important scientific and historical material because of disintegration or obsolescence. Already gone is up to 20 percent of the data collected on Jet Propulsion Laboratory computers during NASA's 1976 Viking mission to Mars. Also at risk are 4,000 reels of census data stored in a form at so obscure that archivists doubt they'll be able to recover it. By next year, 75 percent of federal government records will be in electronic form, and no one is sure how much of it will be readable in as little as 10 years. "The more technologically advanced we get, the more fragile we become," says Abby Smith of the Council on Library and Information Resources. For years, computer scientists said the ones and zeros of digital data would stick around forever. They were wrong. Tests by the National Media Lab, a Minnesota-based government and industry consortium, found that magnetic tapes might last only a decade, depending on storage conditions. The fate of floppy disks, videotape and hard drives is just as bleak. Even the CD-ROM, once touted as indestructible, is proving vulnerable to stray magnetic fields, oxidation, humidity and material decay. The fragility of electronic media isn't the only problem. Much of the hardware and software configurations needed to tease intelligible information from preserved disks and tapes are disappearing in the name of progress. "Technology is moving too quickly," says Charlie Mayn, who runs the Special Media Preservation lab at the National Archives. He speaks from experience. In the 1980s, the Archives t ransferred some 200,000 documents and images onto optical disks, which are in danger of becoming indecipherable because the system archivists used is no longer on the market. "Any technology can go the way of eight-track and Betamax," says Smith, whose own dissertation is trapped on an obsolete 5e-inch floppy. "Information doesn't have much of a chance, unless you keep a museum of tape players and PCs around." That may not be such a farfetched idea. Mayn's temperature- controlled lab in the bowels of the National Archives houses many machines once used to record history. In one room, archivists are resurrecting the 1948 whistle-stop oratory of President Harry Truman; the give-'em-hell speeches were recorded on spools of thin steel wire, an ancestor of reel-to- reel tape recordings. Though some of the wires have rusted and snap during playback, Mayn and his team are busy "migrating," or transferring, what they're able to recover onto more stable modern media. Unfortunately, migration isn't a perfect solution. "Sometimes not all the data makes the trip," says Smith. Recently the Food and Drug Administration said that some pharmaceutical companies were finding errors as they transferred drug-testing data from Unix to Windows NT operating systems. In some instances, the errors resulted in blood-pressure numbers that were randomly off by up to eight digits. So what's to be done? "That's a question no one really has an answer for," says Smith. A good way to start is to separate the inconsequential from the historic, and save on simple formats. Making those decisions
