When I was possessed by evil spirits this winter I went to a medicine man. He listened to my hacking, rib-cracking cough, waved odd-shaped wands and instruments over me, then wrote strange hieroglyphics on a prescription pad.
I was cured.
The everyday miracles of modern medicine are farther beyond my grasp than snapshots from an MRI. I don't know how the magic dust and strange curing contraptions work, but I have an unquestioning faith that they can do almost anything, and I don't care what they cost when the bad spirits of virus or disease attack me or my family.
I once knew a college professor who called that attitude "cathedrals in medicine." Just as mankind once invested enormous resources in cathedrals to buy first-class tickets to heaven, modern man builds cathedrals in medicine - hospitals, research, technology - to wring out every last drip of life on Earth.
The analogy still fits. America has the world's most modern and sophisticated medical care - organized like a European village in the 14th Century.
Worker-serfs form groups to get protection by pledging their loyalty and insurance taxes to doctor-knights; who pledge their loyalty and services to the powerful feudal lords of managed care; who play a chess game to take each other's knights, pawns and treasure.
Some HMO castles would make the Sheriff of Nottingham blush.
A Minneapolis-based HMO company paid board members $109,000 for each meeting they attended in 1994.
Last week, Ohio's Joint Legislative Welfare Oversight Committee reported that, "Compensation for the 10 most highly compensated employees of Ohio HMOs in 1994 was $21,465,100.82" - which averages $2.1 million each.
The report said some non-profit HMOs serving the poor had higher profits than for-profit HMOs, and Ohio HMOs had "revenue growth 167 percent higher than enrollment growth."
Such discoveries "give rise to the fact that some HMOs are making sizable profits and paying large salaries to their directors, CEOs and top 10 executives," said Rep. Robert Netzley, R-Laura, chairman of the House Insurance Committee.
Mr. Netzley and House Speaker Bill Batchelder, R-Medina, are working on laws to require better disclosure and regulation. They even use the word "excessive" - which Republicans seldom speak in the same Zip Code with profits.
But patients aren't the only pawns. Cost cutting is doing to doctors what crossbows did to knights: Heroic Dr. Welby has been reduced to an ordinary, very vincible, medical mechanic.
Some HMO doctors feel like paper-pushers in lab coats, with less time for patients, less authority, gag rules to muzzle complaints, and 40 percent less income. Costly specialists are an endangered species.
But doctors are lucky compared to hospitals, where cost-cutting could spread a plague like the Black Death that wiped out nearly half of Europe in the 1300s. The Cincinnati area is already showing symptoms, with twice the licensed hospital beds it needs.
To survive, hospitals are forming alliances for mutual protection. And public hospitals, like University Hospital in Cincinnati, are going private to cut costs and reduce regulations.
University Hospital's cost complaints may or may not justify going private, but they are an amazing public confession of waste at taxpayer-supported institutions:
Thanks to the generous state retirement plan for public employees, and unions for every worker from residents to cafeteria servers, labor costs are 35 percent higher than for non-public hospitals.
State regulations raise construction costs by another 35 percent.
And services purchased from University of Cincinnati - parking, security, telecommunications, etc. - also cost 35 percent more than private prices.
"They have never thought about efficiencies that other hospitals have been working on for years," said Tom Murphy, a Kroger vice president who studies health care for Kroger, Procter & Gamble, Cincinnati Bell, GE and Federated.
That "Big Five" of Cincinnati's top employers is now working on a comparison of HMOs similar to the studies it used like thumb screws to make local hospitals restrain spending.
Mr. Murphy said, "I don't think there's any question" that some local hospitals will have to close.
Fewer hospitals. Fewer specialists. Rationed care. Excess profits. Doctors treated like vassals. Why does the future look like the Dark Ages?
I'm all in favor of slaying waste. But the Crusades launched by Queen Hillary are squeezing the balloon at the bottom so it can bulge profits and inflate salaries at the top of HMOs.
I don't expect "savings" to benefit serfs like me. I just expect to find a good medicine man when I need one. Call me superstitious, but I don't think an overpaid HMO executive can cure anything.
Peter Bronson is editorial page editor of The Enquirer. If you have questions or comments, call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
