Exposed: HMO Torture Memo

As Dr. Scott Gottlieb, "a partner to a firm that invests in health-care companies," explains that the "surest way to intensify flaws in the delivery of health care is to extend a Medicare-like 'public option' into more corners of the private market," it seems only fair to balance the debate with a secret memo from the files of one of those enterprises in which the good doctor has such faith:

TO: Claims Prevention Department

FROM: President, HMO

Bills are being processed and paid without full use of our avoidance procedures. Such negligence impacts your company’s bottom line, let me review our guidelines:

1. Use the response “require more information from physician” to its full extent. Some providers fill in code numbers, diagnoses and dates of treatment. But who are these people? Can we trust them with the health of our insured not knowing when and where they went to medical school, how long they have been practicing, and whether they rent or own their Lexuses?

2. Handle phone queries properly. Quick answers deprive members of full participation in their care. For the persistent, employ your half-hour hold capability and, if that fails, tell them the computer is down and promise to call back. That will keep them close to their phones and away from doctors’ offices.

3. Don’t confuse claimants with data overload. Just indicate service is not covered because of a,b,c,d,z or some combination. Our forms make definitions of a,b,c,d,z easily comprehensible with the aid of a magnifying glass and legal dictionary.

4. Use “pre-existing condition” as a disqualification. If enrollees are treated for back pain or headaches, assume they had backs and heads before signing up. Are we to pay for problems that should have been treated in the past?

5. When all else fails, deny reimbursement with “This claim has been previously considered.” By the time the patient, physician, laboratory and hospital check with one another, no one will be sure who sent or received what. We should not pay twice or, better yet, once.

We will soon have new tools to aid in your work. A revised schedule of “customary fees” will reflect the global economy by factoring in provider charges of emerging nations. And our accountants are number-crunching the promising concept of a receding deductible.

Our new non-discriminatory policy of hiring applicants regardless of IQ, education or Attention Deficit Disorder will insure better performance in the future. Remember: A claim denied or delayed is a drop of lifeblood to the health of our organization.

Dr. Gottlieb and others may claim the memo is a hoax, but millions of Americans will testify that it understates the reality of what he glorifies as "inherently personal transactions between doctors and patients."

Keeping Faith

Sen. John McCain is suspending his campaign for the next two days to observe Rosh Hoshonna with his friend, Sen. Joe Lieberman, by attending services in Miami to offer up prayers for the people of Israel and the Wall Street victims of Lehman Brothers and Goldman Sachs.

Former President Bill Clinton, who had previously announced he would not be campaigning for Barack Obama until after the Jewish holidays, commented on entering a synagogue in Chappaqua with his wife, "Hillary represents more people of the Hebrew faith than any other Senator and was honored in the recent primaries by more votes than any other candidate from Jewish women, who have started a web site, 'MazelTov2012.com' on her behalf."

Sen. Barack Obama responded by pointing out that, although he would be non-observant today, he is supported by millions of small contributions from young people with Jewish surnames and that David Axelrod is running a kosher campaign on his behalf.

No word as yet on which candidates will be fasting for Yom Kippur next week.

President Gore, Lame Duck

Reading “Going After Gore” in the current Vanity Fair, another reminder of the disaster that befell the nation in November, 2000 and the media's share of the blame, prompts a re-posting of this what-if from last December:

As Al Gore faces his final years in the White House, history will view his two terms as disappointing.

After a razor-thin victory over George Bush in 2000, the new President was ultra-cautious.

Republicans labeled him “Al Bore” for failing to pursue a muscular foreign policy and for endless consultations with UN members, NATO allies, even potential adversaries such as North Korea and Iran.

Then he overreacted to such criticism, using an intelligence report in August, 2001, as pretext for striking defenseless camps in Afghanistan and Pakistan, arousing protests throughout the Middle East over the death of a populist leader, Osama bin Laden, and his followers.

Even more controversial was Gore’s expulsion of fifteen visitors from our ally, Saudi Arabia, for what Rush Limbaugh sarcastically termed “the heinous crime of taking flying lessons.”

The furor drove oil prices to $30 a barrel, with public protest bringing the President’s approval ratings down to 50 percent.

After that, Gore reverted to consensus by pushing for UN inspections in Iraq for weapons of mass destruction, which were never found. This diplomatic waffling, critics claim, diminished the U.S.’s standing in the world.

On the domestic front, the President refused to stimulate the economy with tax cuts, despite an ongoing budget surplus, and pushed for crippling limits on industrial emissions to reduce the so-called greenhouse effect.

Despite such gaffes, Gore narrowly won reelection in 2004 by reverting to Bill Clinton’s ploy of “It’s the economy, stupid.” His opponent, Steve Forbes, never managed to stir voters with his proposal of a flat income tax.

As 2008 approaches, the blandness of the Gore years may end. Vice-President Joe Lieberman, with a lock on the Democratic nomination, favors an aggressive American stance in the world. He will likely face George W. Bush, who claims Gore's election sent the country into a downward spiral.

A major issue will be terrorism which, relatively quiescent in eight years of diplomatic bumbling, may come to the fore again when a new President has America acting like a superpower again.

The question in 2008 will be: How do we let the rest of the world know we can no longer be pushed around?