These are people just trying to make a living every day, and trying hard to make good choices. There is a community of covered lives, but HMO communities lack the shared assumptions and values characteristic of communities we can recognize, like school, work and home. Members share at least one belief. They care for and even recognize each other. Many try to be fair and responsible.
Health plans recruit new members aggressively.
Here in Chicago, there has not been the same effort to retain old ones, but in other parts of the country with greater managed care penetration, competition for retention is fierce. In Albuquerque, for example, plans advertise their mammography rates in hope of retaining their customers. But for all the scoffing at managed care organizations, especially those whose sense of community seems tied to their stock price, these organizations can take moral positions currently out of reach of ordinary, individual doctors and patients. By deciding whom to contract with for services and whom to avoid serving. But to pull doctors, patients and health plans together, the shared values will have to be explicit, even if they turn out to be money, prudence and fairness to others.