Why I belong to an HMO

One of the things the Government hopes to do with the new health legislation is to bring American health status up to the standards set in other developed nations. Our system does not let people die in the streets because they can not afford to see a doctor, so our problem is not denial of care. Nor is it the quality of medical services, at least in the sense of the quality of diagnistic and therapeutic services applied in hospitals not the quality of drugs prescribed to patients. We pay more for medical services than do any other people in the world, and we get good quality for all that money.

The problem is that we don't apply relatively simple educational and preventive health services in a timely fashion, and therefore find ourselves having to provide complex medical services to people after they have gotten sick, often very sick. We avoid the inexpensive preventive services and wind up paying for the expensive curative services, or worse the very expensive terminal medical care.

My HMO is good about providing preventive services and health education. Not only does that save me money, it is likely to help me avoid illness.

The reforms introduced by the new health legislation should have this factor in vies. Simply by making primary health care services available to 40 million people who now are deterred from their use due to the lack of health insurance, a lot can be done.

It is also important, however, that the legislation encourage the provision of preventive care and health education. The economic incentives to providers should be to help patients avoid getting sick, rather than to wait until they are sick to provide curative services. And of course, the costs of "defensive medicine" should be reduced, funding services only when it is likely that they will in fact be useful.