NEW YORK--Yogi Berra had the last word at a panel discussion on health-care reform sponsored by the Medical Society of the State of New York. Television talk show host Larry King moderated the discussion and fielded the caustic remarks of doctors, pharmacists, and medical students who packed a Waldorf-Astoria ballroom to debate whether quality medical care can be maintained under health-care reform.
No one was optimistic. But what to do? Mr. King quoted the New York Yankee catcher: "When you come to a fork in the road, take it." This typically ambiguous Yogi-ism reflected the audience's evident distress with health-care reform--all forks seem to lead to managed care.
The land-mine ahead that seemed to most worry those at the meeting is whether health maintenance organizations (HMOs) and other managed care plans can provide quality care. "Will physicians be making the ultimate decisions about treatment or will that be left to clerks who don't have any medical background," a medical student in the audience asked, to big applause.
"No HMO would ever consult anybody but a physician to make a medical decision," panelist Karen Ignagni, president of Group Health Association of America, a trade association of HMOs, reassured the student.
Speaking as the only representative of a managed care plan on the panel, Ms. Ignagni noted that the various forms of managed care may differ in how they operate, but that in HMOs, medical decisions are always made by physicians. She added that HMOs have a track record of providing quality service.
But not everybody was reassured. "May I tell you why I'm seriously contemplating leaving the practice of medicine," said a physician in the audience with some 50 years in practice. He had received a letter from a managed care plan that began 'Dear participating provider.'
"You see? I used to be a physician; now I'm a participating provider," the physician said. "The letter goes on to say that only one hospital will be allowed to do my patient's heart operation. You choose a hospital because it has the lowest incidence of side effects, and they can change it without any due process."
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
