Empire State Medical Association (ESMA) Recommendations to Reduce Health Disparities

Rationale: Health maintenance organizations (HMOs) are the middle men of medicine.

HMOs deliver no health care and value interests of investors, shareholders, and executive compensation more disproportionately than those of patients. Revenues that could be directed to health care infrastructure is often used for corporate profit.

Legislation must be passed to make healthcare a basic human right – not a privilege. Over 45 million Americans have no health insurance. Countless millions more are incompletely insured and one catastrophic illness away from bankruptcy.

The concepts of referral use and capitation by HMOs discourage the physician patient encounter which delays access to health care. Health care delays increase costs by increasing expensive emergency room visits and hospital admissions for serious illness, leading to the closure of many hospitals.

In New York hospitals have lost approximately $750 million in the same year HMOs in the city have demonstrated over $750 million in profits. HMOs frequently cherry pick profitable healthy patients but leave millions - including the elderly and those with pre-existing conditions - uninsured. HMOs also often have prohibitive deductibles and patient out of pocket expenses, further taking money from patients to protect profits. Tighter regulation of HMOs and centralizing care to a few would contain costs spent on administration and allow patients and hospitals to thrive.

Existing government insurances should be expanded to allow New Yorkers to buy in. Expanding Medicaid, Child Health Plus, Healthy NY program and Medicare to insure all New Yorkers would be the ideal prototype for universal access to quality health care.