control, thanks to medical bureaucracy, and just plain greed. At the beginning of the 1990s, there were nearly 600 HMOs across America and they were regarded as a practical alternative to escalating medical costs. By 1998, it was clear that HMOs were out of control, leaving a trail of angry and neglected patients in their path. Physicians have also begun speaking out against HMOs in increasing numbers. According to Dr. Daniel J. Esposito, the main problem with HMOs is that, "there are no economic incentives to take care of people. The incentive is not to do anything" ("More Trouble With Managed Care" PG).What happened? How could something, which started out so promising, have gone so terribly wrong? In a survey conducted by Harvard University in conjunction with the Kaiser Family foundation, it was revealed that 51 percent of Americans polled believe that HMOs are responsible for the deteriorating quality of their health care. Fifty-five percent expressed concern that HMOs were more preoccupied with cost-cutting measures than with providing the best possible medical care for the patients they serve ("The HMOs Image Problem; Public Distrust Can be Cured By Ensuring Patient Rights" 8). This certainly does not sound like the all-purpose solution to quality and affordable medical care the government was looking for when it began addressing the issue of a national citizens' health plan back in the 1960s.What has sparked this widespread public mistrust of HMOs? Part of the problem has been the exceptional growth of HMOs during the 1990s. By 1996, HMOs boasted a membership of 110 million enrollees, a figure four times higher than 1986 (Evans). The federal government's attempts at reform have only added fuel to the growing fire. With their ineffectual price controls and budget slashing, the bottom line is that people are receiving less health care instead of more -- hospital stays and specialist referrals are kept at a minimum to defra...
