Plan-Physician Cooperation: A Few Small Steps on the Road

John Marcille

The things that cost us the most often come without price tags, just as the things we value the most usually can't be bought. Senior Editor Frank Diamond's cover story concerns hidden costs resulting from the oft-strained relationships between HMOs and physicians.

A substantial portion of this figure — whatever it is — is hidden from us. That's because you just can't calculate the cumulative price of countless moments of mistrust.

If magazines had a cutting-room floor, as movie studios are supposed to have, then it would be filled with metaphors, similies, and wonderfully crafted sentences that just didn't advance the story. Here are some lines, cut from the article that we've decided to resurrect here:

Michael L. Millenson, of William M. Mercer, uses a military analogy to describe much of what HMOs want practices to do. He says the U.S. built an entire arsenal of nuclear artillery shells during the Cold War.

"The shells last a certain amount of time, and then you've got to get rid of them," he notes. "We never fired a nuclear artillery shell in defense of Europe. You could argue that having nuclear artillery shells was a useless expense. The counterargument is that the shells deterred war, which would have cost us a great deal more. Similarly, managed care companies will tell you that their administrative requirements prevent expensive waste or episodes of acute illness if best practices are followed. Critics say that interferes with doctors doing their jobs."

Someone once said that it is much more vital to know the philosophy of another country than to know the location and size of its army. Great Britain has a much more formidable fighting force than Iran, Iraq, or North Korea. However, we do not have to be on guard against London.

Thoughts are things; attitude matters. Until hearts change — and the world is full of trouble spots that make the bumps in managed care seem trivial — then costs will mount.

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