Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
In Reply: Dr Coulter views yesterday's market
failures as prelude to tomorrow's successes. Last year the number of uninsured
people increased by another million, Medicare HMOs ejected hundreds of thousands
of patients, and HMOs announced 10% premium increases. How long should we
wait for the market to work?
The competitive free medical market that Coulter mentions is more an
insurance executive's fantasy than patient-experienced reality. Employers,
not patients, choose health plans. Only 20% of small firms offer more than
1 health plan; even among large firms, less than a third offer more than 2
plans.1 The choices patients really want—of
physician and treatment options—are usurped by profit-driven insurers.
Himmelstein DU, Woolhandler S, Hellander I, Wolfe SM. Quality of Health Care and the HMO Marketplace—Reply. JAMA. 2000;283(5):602-605. doi:10.1001/jama.283.5.601