HMOs’ Fevered Pitch

U.S. Healthcare

Louis Armstrong sings “Got a Lot of Living to Do” as hard bodies surf, dance, and frolic across the screen. A seaside yuppie utopia? No, just the optimum clientele for this fast-growing, very profitable HMO, used by 1.9 million members in the mid-Atlantic states. The ploy: attract customers who will stay healthy. Let’s hope it works, because this HMO spends less on care than any other–72.9 cents of every dollar, instead of the average 78 cents. This creates a healthy bottom line for CEO Leonard Abramson, whose annual $9.8 million tops any other HMO executive’s pay.

HMO Blue of New Jersey

Assorted faces shriek, tonsils flailing, into the camera. A serial killer? Frankenstein? Much worse, the narrator tells us: They see the rising cost of health care. But the ad’s message–managed-care plans cut costs–doesn’t stand up. Industry experts report savings caused by early changes (e.g., reducing hospital stays) are finite, and costs will soar again. Ordinary Americans are already feeling the pinch: Last year, 1.1 million joined the ranks of the 40 million already uninsured. Now that’s scary.

Health Insurance Plan of New York

Lyn Schwan, with her tousled hair and cool cat-eye glasses, praises the “great, great” pediatric care and easy access to the doctors of Gotham’s oldest HMO, which delivers care to 1.1 million members through neighborhood centers. Lyn’s verite testimony is key to HIP’s video facelift. If only it were true. Enrollees of the plan ranked HIP’s quality the lowest of 21 HMOs in an industrywide survey. And unlike Lyn, they gave HIP an “F” for access to their preferred doctor.

Aetna Health Plans

“I am a nurse first, and I am an Aetna employee second,” narrates Jo Glenn. Message: Aetna shares the priorities of this pro-patient nurse. Reality: Managed-care HMOs such as Aetna increasingly use review nurses–who often don’t even meet individual patients–to monitor and second-guess physicians’ treatments. Containing cost is priority number one for these corporate nurses. The Service Employees International Union, which represents nurses, predicts unemployment for hundreds of thousands of hospital nurses because of managed care’s budgeting knife. Jo’s colleagues may soon be out of their jobs.

Secure Horizons

A vibrant 102-year-old named Lula who suffers from diabetes is this Medicare HMO’s too-perfect spokesmodel. In fact, “Lula” is played by an actress who’s just 89, and is based only loosely on a 102-year-old Secure Horizons client named Ernestine. Ernestine doesn’t have diabetes, but rather what one Secure Horizons staffer describes as a “more frightening” condition. And while Lula says that she wanted to join the HMO, Ernestine had to in order to keep her doctor, whose practice was bought by Secure Horizons’ parent company, Pacificare. Lula tells us she is grateful that the HMO accepted her despite her age and her condition. Actually, the HMO did her no special favors: Medicare HMOs are required to accept all applicants.

And it’s only going to become more confusing from here. With government health reform long dead, managed-care plans are engaged in an intense struggle over market share, and only a handful of companies in each region will survive. Let the buyer beware. Stuart Schear is a media fellow of the Henry J. Kaiser Family Foundation