The exercise of judgment, discretion, and mercy at the server-patient level is relentlessly eroded by the forces of mammon the giant HMOs, their masterminding corporate law firms, and their political allies who safeguard their immunities and privileges in the face of growing public and professional outrage. This was not the way it was supposed to turn out, at least in the minds of the pioneers of prepaid medicine. Commencing in the 1920s with Dr. Michael Shadid's mobilization of poor farmers around Elk City, Okla., to form the first cooperatively owned hospital in America, and then the Puget Sound and Kaiser Permanente health care plans, the ideal was to create quality health care with attention to preventive services within an affordable system of prepayment. A dominant format also emerged the giant, for-profit HMOs and their entrepreneurial billionaire bosses securing large clusters of customers and seeking more and more mergers. The giant HMO and its deepening swamp of commercialism over service, of profiteering over professionalism, of denial or rationing of care where such care is critically needed, of depersonalization of intensely personal kinds of relationships, are spreading without sufficient disclosure, accountability, and structural responsibility, to the detriment of life and health.
Workable alternatives are available.
The underfunded Canadian universal health care system is still probably the best in the world, despite attempts by companies and corporate ideologues in North America to undermine and weaken it. For around 10 percent of its GNP, Canada provides health care for everyone from the cradle to the nursing home. In Making a Killing, Jamie Court and Frank Smith make this story and its lethal consequences painfully clear. They searched and researched evidence, from inside the industry, the public records, the court judgments, and the documentation of personal tragedies flowing from HMO priorities, and they found patterns, not just episodes or examples. Venerable institutions and traditions in need of improvement are instead shut down and destroyed before the onrushing corporate Moloch.