As an 88-year-old, longtime subscriber, I would like to congratulate Newsweek on the Nov. 8 cover story about HMOs (“Critical Condition,” Focus on Your Health). Too often, the media seem unwilling to take on powerful business interests, and health insurance has become very big business indeed in a few short years. Doctors are no longer entrusted with many life-and-death decisions; hospitals are no longer able to keep patients until they are strong enough to go home; sick people who go for help are no longer asked, “What can we do for you?” but “What health insurance do you have?” And the HMOs seem more concerned about their stockholders than they are about their policyholders. Beatrice Henshaw Petoskey, Mich.
Since I bang heads with HMOs and various flavors of managed-care plans on a daily basis, I found your cover to be right on target. My patients are constantly asking why the practice of medicine has been taken out of our hands and left to the insurance-company suits. They also question how administrators of managed-care plans can know more of what’s best for their health than we do. I have a hard time answering them. To show my disdain for health-insurance companies and my sympathy for my patients’ predicaments, I copied the cover of your HMO issue and tacked it on the ceiling above my examining tables. Now, while I’m doing my best to explain to my patients what I can’t do for them and why, they can glance up and see for themselves how I feel about the current state of affairs. Charles Cusumano Physician Assistant/Certified Campbellsville, Ky.
Your Nov. 8 cover story on managed health care made many good points–most important among them that “the health-care system is a mess” and that “millions of Americans receive flawed or inadequate medical care each year,” no matter what kind of health insurance they have. Your piece quoted a recent Institute of Medicine study that concluded that “quality of care is the problem, not managed care.” And your fourth annual health-plan rankings showed many with outstanding scores for high-quality service and care. Unfortunately, the blaring cover headline HMO hell was at odds with the more balanced content inside and pandered to the lowest common denominator in the current health-care debate. Those who continue to make a convenient villain of the managed-care industry do not serve the end of improving health-care quality or reducing the number of uninsured Americans. Studies show clearly that managed care has improved many aspects of medical care–significantly increasing the number of people who get needed preventive health services, for example. And without the cost saving attributable to the industry over the last decade, several million more Americans would be uninsured today. Our health system is beset with complex problems. We will not solve them by perpetuating the myth that managed care is to blame. Nancy Chockley President, National Institute for Health Care Management Foundation Washington, D.C.
I am a 24-year-old woman living with an eating and exercise disorder. Years of relentless exercise and restricted eating have resulted in, among other things, an extremely low rate of metabolism, stress fractures and the early stages of osteoporosis. I want nothing more than to be healthy again, but for the past six months, I have been fighting with my HMO. It does not cover these health issues, and managed care does not suggest any alternatives after saying no. Your feature on HMOs, while it didn’t provide any solutions to my problems, at least gave me some relief that I am not the only one out there desperately trying to reconcile my need to get better with my health plan’s bottom line. Name Withheld Washington, D.C.
Managed care has come a long way in the past decade. Just as physicians and health-care providers have had to change from fighting acute illnesses like tuberculosis, polio and smallpox, managed-care organizations have had to adjust the way they provide coverage to participants. No longer can health-care plans simply provide coverage for an antibiotic to cure an illness; they now provide a system where patients can receive years of consistent treatment, education and care. Are there occasional foul-ups? Perhaps, but in a universe of more than 100 million Americans enrolled in some form of managed care, the bad events (and actors) aren’t anywhere close to the prevalence your article suggested. Patrick G. Hays President, BlueCross BlueShield Association Chicago, Ill.
Now that I have picked myself up from the floor, where I fell in astonishment after reading your HMO article, I have to ask the HMO executives who think they are so misunderstood, “Who do you think you are fooling?” Do they really expect us to believe that medical decisions “are always made by doctors, not by nurses or clerks”? Well, I worked for five years as a clerk for a major health insurer, and I never saw any decisions get even as far as a nurse! We clerks made the decision 99.9 percent of the time, based on the health plan’s requirements. It’s time these executives woke up and realized that America is not going to stand for the lies anymore. My advice to anyone seeking a decision on a treatment is: insist that your case be reviewed by a physician. Go to your human-resources department and ask that it get involved. Do not give up! Jane Headding Fresno, Calif.
Your cover headline “HMO Hell” was a misnomer. it should have been “American Health-Care Hell.” To blame HMOs (or managed care in general) for the current mess is like blaming your umbrella for the fact that it’s raining. We would have been in this miserable situation a decade ago if not for managed care. I remember hearing projections in the mid-’80s that by the year 2000, health care would consume 20 percent of GDP (gross domestic product); it then stood at 10.3 percent. Now it’s about 14 percent. This relatively modest increase in health-care costs has contributed in no small way to the economic good times we’ve been experiencing in the last nine years. But instead of being grateful, the public is outraged. I’m sorry, but I don’t get it. Americans have voracious appetites for health-care services, and they firmly believe that doctors can fix anything, from viral infections to loneliness. When we fail to live up to these unrealistic expectations, the blame falls on us or the system of care we practice in. The expectations themselves, however, are never challenged. Even the best umbrella can’t provide much protection in a gale. Unless we stop pointing fingers and start having a rational dialogue, I fear the gale will develop into a hurricane. Laura Patton, M.D. Edmonds, Wash.
How interesting that your article “HMOs Go Under the Knife” (Focus on Your Health, Nov. 8) should begin with my profession of dentistry, where HMOs have already started to spread like a metastasizing cancer. As health-care providers, we should learn from our medical colleagues and simply throw away the relentless HMO solicitations. After 21 years in private practice, I can read trust and appreciation in a patient’s eyes, because all decisions regarding an honest, fair and reasonable treatment plan are made just between the two of us. This experiment in health-care reform has failed because private corporations have taken the balance of power away from the doctors and patients who used to be partners in care. Gary Dadaian, D.M.D. Cresskill, N.J.
As an Orthodox Jewish American, I worry that people may form their opinions of Hasidic Jewry based on your excerpt from “Chosen by God: A Brother’s Journey” by Joshua Hammer (“A Tale of Two Brothers,” Society, Nov. 8). In this era of anti-Semitism, we cannot afford to be misrepresented this way. It must be made clear that this story is not about Hasidim; rather, it is the story of a lost soul who has found some comfort living a very extreme lifestyle. “Tuvia” obviously takes pleasure in shocking his estranged brother, Joshua, by presenting his religious beliefs in a most extreme and caustic manner. This is certainly not a man who typifies the American Hasid! According to Proverbs 3:17, “The ways of the [Torah] are pleasant and all its paths are peace.” When Tuvia Hammer’s views and manner of communicating with his brother begin to reflect this verse, he will begin to achieve the inner peace he is so desperately seeking. Shabsai Horowitz Passaic, N.J.
For nearly two decades, my mother and I wondered what had happened to my sister and her husband and kids. Like Joshua Hammer’s brother, they, too, had become ultra-Orthodox Jews, and we figured that they must have landed in some sort of cult. The last time we saw them, 16 years ago, their house was a chaotic mess, much like Joshua’s description of his brother’s house. My mother and I were allowed to baby-sit for the kids for the day, and I made the grand mistake of wearing a bikini in the backyard on that hot summer day. That was the end of the relationship, and from reading this book excerpt, I understand a little bit more why this happened: my sister did not want my modern-day ways to influence her children. Today I’m trying to locate her through various search services because of a severe illness in our family, and I desperately hope that somehow, some way, there can be some healing before it is too late. I don’t really know if I’ll ever find her, and if I do, I doubt I’ll really want to get involved with her life. The bottom line: thank you for printing this excerpt, because it’s given me more understanding and information about the tragic and destructive path my family has been on for so long. I will be first in line to buy Hammer’s book so I can get a better glimpse into the world in which we believe my sister and her family have disappeared. Again, Joshua, thank you for writing this book. Marilyn Zelinsky Syarto Fairfield, Conn.
Regarding your article on the Hasidic brother’s journey: I would like to clarify that there is nothing derogatory in our Torah about African-Americans or Gentiles. God created them, too. If Hammer had spent a little more time in the Boisbriand community near Montreal, he would have known that not everyone there is sitting and learning the Talmud all day. Going from house to house, he would have seen that one man is a jeweler, one owns a lumberyard and one has a sweater factory. Just because people are Hasidic doesn’t mean they are all scholars. Plenty are businessmen, too. And about the ladies… yes, in the freezing Canadian winter months, they don’t get to socialize much. But come spring the women sit in clusters on their lawns discussing anything from Princess Diana to the latest medical developments. We are not so prehistoric or sheltered from the outside world as some may think. Naomi B. Brooklyn, N.Y.
My daughter is pregnant with her ninth child, having become an ultra-Orthodox Jew at about the same age that Joshua Hammer’s brother did. Like his family, ours is made up of secular, liberal Jews. I’m familiar with the practices and beliefs he describes, and find distasteful the critical attitude toward minorities and the larger world expressed by some of these people. However, my daughter’s community is very close, and each time she’s brought home a new baby, her neighbors have taken one or two of the older children for days on end. Although I’ve had to walk a fine line, I’ve never lost touch with this daughter. Judith Isaacs Marlton, N.J.
I wondered why my own experience with Orthodox Jews was so different from Joshua Hammer’s. As a Presbyterian minister from South Korea, I was an obvious outsider when I studied an Orthodox community in Los Angeles for more than 10 years. While no group that I know of is entirely without its bigots and small minds, for the most part I was treated with respect and warmth, from which grew lasting friendships that I still cherish. My pastoral experience provided the answer to my question above. When people join a religious group, they do not leave their personalities at the door. Great teachings can turn ugly when they are interpreted by people with their own agendas. Joshua Hammer’s journey may have taken him more deeply into the mind of his brother than into the exotic–but generally principled and admirable–lifestyle of some genuinely good people. Rev. Yong-Soo Hyun Los Angeles, Calif.
As an Orthodox woman who has drifted between the secular and the ultra-Orthodox world, I found that Hammer’s vivid description of his brother’s life in Monsey, N.Y., rang true–but only up to a point. For one thing, not all ultra-Orthodox Jews harbor the harsh prejudices that Hammer describes. My family lives in a very assimilated section of New York’s Westchester County, where the secular existence is one that I have found to be isolating and nonnurturing. I recently enrolled my son, who had gone to public school his whole life, in an ultra-Orthodox, “black hat” yeshiva in Monsey. I cannot praise the Monsey community enough. It has given my son–a bright, but previously sullen and troubled boy–a sense of family and community that he never had in our “soccer mom” haven. He now spends 14-hour days in high school, primarily immersed in learning Torah, and he has gone from being a drifter to finding a purpose and structure for his life. His role models have shifted from druggie rock stars to wise rebbes, and on his days back home in the “wilds of Westchester,” instead of quoting bawdy rap lyrics like other kids his age, he delights in recounting stories of the sages. I wouldn’t trade those Jewish role models for all the celebrities in People magazine. The warmth and beauty that the Monsey community has wholeheartedly extended to my family over the years has been a lifeline to us. Judith Lederman Irvington, N.Y.
In our Nov. 1 story about the fall of the Berlin wall (“Behind the Wall’s Fall,” International), a segment about Polish dissident Adam Michnik was mistakenly accompanied by a photo of former Czech Republic prime minister Petr Pithart.
