A big merger in health care? Beware ...

Counterpoint

The Star Tribune Editorial Board ("A promising medical marriage," Sept. 10) lauds the merger of HealthPartners (an HMO "payer" and hospital/clinic system) with Park Nicollet (a large hospital/clinic system), as a "promising example of how regional institutions have the freedom to attack the problem of delivering better care at better prices" -- a merger rewarded financially for keeping "people healthy ... instead of putting them in the hospital."

A common slogan is, pay for well care, not sick care.

Patients and editorialists beware. These systems' doctors are under powerful commercial and political pressure and even coercion to become corporate-rationing-of-care gatekeepers enlisted to manage the cost-of-care problem. The slogans are accountability, quality and efficiency.

Too bad sloganeering doesn't work. As the editorial pointed out, the similar 1990s Minnesota combination of the Medica HMO "payer" and the Allina hospital system failed to produce "significant cost or quality improvements."

Pundits would have us believe that massive system computerization with businesslike controls of alleged profligate clinician and hospital spending will now bring us a big-box, corporate "health service" nirvana producing cheaper population health in the same manner that Intel produces cheap computer chips or the Cheesecake Factory produces cheap meals. What's wrong with this picture?

Dr. Andy Powsner (a Yale psychiatrist) noted that "a business analogy fails to consider that medical care is a repair service, not a manufacturing operation. ... Medical care is stuck with faulty carbon-based people who walk in the door to receive treatments. ... People do want some things repaired -- usually, their friends and family."

Dr. Peter Dehnel (a Minneapolis pediatrician) recently wrote that: "Assembly line production works in the food service sector as it does in the automobile and airline manufacturing industries, and with excellent quality outcomes. The "raw materials" are consistent and of high quality and it is easy to automate the production processes. ... Oh yes, most customers actually pay their [own] bill ..."

Doctors can treat the ailments of patients, but not the cost ailment of a managed-care gatekeeping system gone awry, when the problem is a plague of popular tax-subsidized "free" care demand inflation.

Bigger merged and computerized corporate "health services" insuring population care and programmed to use doctors as gatekeepers of "payer" money contain no magic that can "produce health" to control system costs.

Managed-care systems, corporate here and nationalized abroad, balance budgets by caring for the many inexpensive well ("well care") and by queuing the few expensive ill ("sick care"). What counts in all gatekeeper systems is what is countable: money, not health.

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Dr. Robert W. Geist lives in North Oaks.