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  •   Art Imitates Life When It Comes to Frustration With HMOs

    By David S. Hilzenrath
    Washington Post Staff Writer
    Tuesday, February 10, 1998; Page C01

    Just as the managed-care industry gears up to combat a political backlash in Congress, it is taking a tongue-lashing in the nation's movie theaters. The film is "As Good as It Gets," but if you're an HMO lobbyist, it doesn't get much worse than this.

    Audiences in the Washington area have been erupting in whoops, whistles and applause when actress Helen Hunt, playing the single mother of a chronically ill child, denounces HMOs with a string of unprintable epithets.

    Hunt's character quickly apologizes for the outburst, but actor Harold Ramis, playing a physician, assures her that the apology is unwarranted.

    "Actually, I think that's their technical name," he says.

    It's the managed-care industry's reward for playing the heavy in the nation's war on rising health-care costs, and it helps explain why many lawmakers view proposed restraints on the industry's cost-cutting powers as a sure way to win votes.

    Some analysts say it would be a mistake to dismiss the applause line -- and similar references in television dramas -- as mere Tinseltown frivolity.

    "I think it has real implications for the managed-care industry's image and what they're going to need to do about it," said Mollyann Brodie, director of special projects for the Henry J. Kaiser Family Foundation in California, which sponsors public opinion research on health care.

    "HMOs have become sort of the villain in our society," Brodie said. "Whether it's fair or not, they have become the easy target."

    In the setup that provokes Hunt's outburst, Ramis's character asks whether the child has been tested for allergies.

    "No," Hunt replies, to the doctor's consternation. "I asked. They said my plan didn't cover it, and that it wasn't necessary anyways."

    The American Association of Health Plans has launched a public relations offensive of its own with soothing, feel-good television ads emphasizing steps the Washington-based HMO group voluntarily has taken to defuse the movement for regulation.

    Amid images of smiling doctors and beaming mothers holding babies, a narrator declares, "We've taken a pledge to make health care better . . . a pledge to help patients get the right care, at the right time, in the right setting."

    So what does the public really think?

    A recently released survey by Harvard University and the Kaiser Family Foundation found that Americans favor certain proposed consumer protections in health care by wide margins. Almost nine of 10 said they would favor a law allowing people to appeal to an independent reviewer if they are denied coverage for a particular medical treatment. More than three of five said patients should be able to sue health plans for malpractice.

    But respondents were much less likely to support such legislation if it would increase the cost of health care or cause employers to drop coverage, the survey found.

    As if reading from the pollsters' script, opponents of health care regulation are emphasizing precisely those threats.

    A recent ad in a Capitol Hill newspaper featured Frankenstein's ghoulish visage and this warning: "Washington: BE CAREFUL HOW YOU PLAY DOCTOR. YOU MIGHT MANDATE A MONSTER."

    Some of the proposed legislation "will drive up costs, forcing millions of Americans to lose their health insurance," the ad said.

    The ad was sponsored by the Health Benefits Coalition, which includes the National Federation of Independent Business, the U.S. Chamber of Commerce, the National Association of Manufacturers, the American Association of Health Plans, the Health Insurance Association of America and other managed-care organizations.

    Echoing the "Harry and Louise" ads used to torpedo President Clinton's health care legislation several years ago, the Frankenstein ad contended that one of the bills Congress is considering "would mandate a monstrous bureaucracy."

    Left unsaid was that, on its own, the private insurance bureaucracy has ballooned in recent years as health plans have bulked up to play a more assertive role in medical care. The overhead costs of private health insurance -- what insurers collect in premiums minus what they pay in claims to doctors, hospitals and the like -- increased 188.5 percent from 1986 to 1996, to $45 billion from $15.6 billion, according to the most recent data available from the Health Care Financing Administration.

    That far outstripped overall growth in both private health insurance premiums -- 140 percent -- and the nation's total spending on health care -- 124.5 percent, according to the HCFA.

    POPULAR CULTURE has been kinder to Heartport Inc., a California company that manufactures instruments used to perform open-heart surgery without splitting apart the breastbone.

    "Chicago Hope," a hospital-based CBS television drama, extolled the benefits of Heartport technology in a recent episode. The technology was used on a pregnant woman whose heart had been damaged, possibly by diet pills. As the surgeon prepared to operate, she told her colleagues: "Okay, folks, minimally invasive Heartport surgery. Less traumatic, less invasive. Hopefully, the baby won't even know we've been there."

    Heartport aired an ad on CBS affiliates during the show, and about 30 affiliates ran segments on the surgical technique during their late news broadcasts, a Heartport spokesman said.

    A Heartport consultant who is a technical adviser to "Chicago Hope" brought the technology to the show's attention.

    Open-heart surgery on pregnant women is "extremely rare," said surgeon Gregory P. Fontana, the technical adviser. "This particular situation, as far as I know, has never happened."

    © Copyright 1998 The Washington Post Company

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