Dearest:   My guest tonight is Margaret A. Mahony MD, aka Peggy, a practicing 
gynecologist in San Jose, CA. Peggy is an advocate for health care reform and is 
devoted to trying to change the health care system. She lectures and speaks to a 
variety of audiences.

She has had a full time private practice in San Jose for 12 years. Her present 
practice is devoted to women's health issues and is focused on prevention and 
wellness in the mid life transition. Dr. Mahony will discuss both menopause and 
the managed health care system tonight. Dr. Mahony is the author of the new book,
"Saving The Soul of Medicine." 
 

Welcome to Power Surge, Dr. Mahony. The House of Representatives is about to 
begin a debate on the "The Patients Bill of Rights." Many of us wonder who will 
really benefit by the passing of this patients bill of rights, the lawyers or 
the patients! What are the key differences between the bills being presented and 
how will the one that passes impact the rights of patients currently using 
HMO's? 


Margaret A. Mahony MD:   There are many similarities between these bills and 
some key differences.  The main difference is whether or not patients will be 
able to sue their health plan either in state or federal court. From my 
perspective as a physician involved with the day to day care of patients this 
bill does not address the real problem which is the profoundly negative impact 
that managed health care has had on nurses, doctors and other health 
professionals.

We now have a serious nationwide shortage of nurses and a physician shortage is 
predicted as 48% of physicians over age 50 will retire in the next 1-3 years. 

Here is my take on this Bill.  What good will it do to be able to sue your 
health plan if there are not enough nurses and doctors left to take care of us 
when we need them.


Dearest:   I think many people are fed up with HMO's, the bureaucracy, the 
limited care they receive because doctors are restricted to a certain amount of 
time with a patient. I wonder, rather than be concerned about suing, why don't 
they correct the real problems with our managed health care, so the patient 
doesn't have to anticipate having to sue? 


Margaret A. Mahony MD:   I could not agree with you more. It is time to revamp 
our system and discuss other alternatives.  One such alternative is the Medical 
Savings Account. This is a different type of private health insurance that would 
replace our present HMOs and PPOs. Do you want me to elaborate? 


Dearest:   Please do. 


Margaret A. Mahony MD:   Medical Savings Accounts were established in 1997 by 
Congress as an alternative to HMOs.  They were initially structured as a pilot 
program and therefore restricted to either individuals or small businesses under 
50 employees.  This pilot program expired at the end of 2000 and pending is 
Congress is a motion to expand Medical Savings Account to all 243 million 
persons with health insurance-they have not done this yet and it is time to ask 
then to do so.  MSAs are structured so the you are paying into the catastrophic 
insurance pool. so that you are covered financially if you have a serious 
illness or accident.

The key difference is that all participants have a Medical Savings Account, like 
an IRA, but only to be used for medical expenses. Tee funds for this comes from 
the present premium which is split into 2 parts. one to pay for catastrophic 
coverage and the into the other into the MSA. As this clear? I will go on just a 
bit further then stop. 


Dearest:   Weren't some of the criticisms of MSA's that 1) health care has 
become so complex that they felt consumers are no longer capable of making cost-
conscious decisions about their treatment and 2) that  consumers will forgo 
necessary or preventive care to save money in their medical savings accounts? 


Margaret A. Mahony MD:   It is a criticism that does not appear to be well 
founded from my perspective. As a practicing doctor taking care of women I can 
tell you that they seem quite capable of making complex decisions about their 
health and health spending.  I can say this because where I practice many people 
are already paying out of pocket for their medical care because they are not 
satisfied with their options and/or treatment in their plans.


Dearest:   And a final question from me -- won't the passing of the patients 
rights bill, ensuring that patients can sue their HMO's ALSO drive up the cost 
of our HMO insurance?  Aren't we paying enough already?


Margaret A. Mahony MD:   The increase in cost of being able to sue your health 
plan is a hotly debated topic and each side has it stats to back up its point. I 
do not have sufficent expertise to answer as it will depend upon exactly what 
the final conditions are. I share with you that that is a concern. 


Dearest:   Thank you, Dr. Mahony. MaryO, go ahead.


MaryO:   A few years ago, I had surgery and followup care at the National 
Institutes of Health (NIH) for a rare disease.  NIH said that I was cured.  The 
next year, my husband's company was going to switch insurance companies.  The 
whole company was rejected because of my history, even though NIH had agreed to 
continue any possible care into the future.  Is it legal for insurance companies 
to reject everyone because of one spouse's past history?  


Margaret A. Mahony MD:   I am sorry. I do not know the answer. I am sorry that 
that happened to you. 


MaryO:   Thanks, anyway  :) 


Froggy4:   What do YOU see, Doctor, as the key items to be revamped?  I know I 
can see the "flat rate" that doctors receive, whether or not they see patients 
as being something that needs to be changed, also the opportunity to seek a 
second opinion when the illness is not responding to treatment, or a doctor 
isn't receptive to any alternatives for treatments, or doesn't believe "the 
patient" is really ill.  (I don't use HMO I use PPO or POS & pay extra for it) 


Margaret A. Mahony MD:   The biggest fix has to be restoring the trust between 
physician and patient. This trust has been eroded primarily because third 
parties payors are influencing what can be done and when and how. This is 
interfering negatively in this relationship.  And the fact that the MSA restores 
responsibility of decision making to the patient and physician is its strongest 
attribute.


Dearest:   Not only that, but how does one form a relationship with an HMO 
doctor when they're so rushed through the examination and often, when the 
patient returns, the doctor has left the HMO? 


Margaret A. Mahony MD:   This idea of quick, hurried doctor visits has got to 
go.  What in the world can be accomplished in 10 or 15 minutes. Perhaps a few 
straightforward urgent problems can be addressed adequately, but this should 
never have evolved to become the norm.


Dearest:   Thank you, Dr. Mahony. Jeanette, go ahead.


Jeanette:   I too have not been happy with my HMO. I have a strong history of 
heart disease in my family and no one seems to want to do any testing on 
me. What are they waiting for, a heart attack?  What can I do short of saying I 
am having chest pains (which I'm not) to get someone to hear my concerns? We 
have our HMO thru a government plan. My husband is retired military and can't 
afford the HMO my husbands employer offers. 


Margaret A. Mahony MD:   You need to make an appointment with your doctor and 
ask for extra time because you have something REALLY important to discuss.


Jeanette:   So, at my annual physical is not the time to discuss this?


Margaret A. Mahony MD:   Then make sure you explain in great detail that you are 
worried about heart disease and that you want any and all pertinent testing. If 
necessary please take a refresher in assertivenes training.  I would make a 
separate appoimtment and bring your husband with you. Make sure that the doctor 
knows how concerned both of you are.


Dearest:   You say in your book that it is going to take grass roots 
involvement to get things changed. How can we as patients and taxpayers effect 
some of those changes?  Other than asking our individual doctors for more time.


Margaret A. Mahony MD:   What all of need to realize is that we have a lot more 
influence than we think.  For instance, hospitals are supposed to serve the 
members of the community that they are in.  I believe that this service to the 
community has been forgotten in too many circumstances. One thing that members 
of the community can do is to lobby their local hospital boards  and ask that 
their hospital adopt the Planetree philosophy of hospital care --that puts the 
patient first. Interested persons can visit their web site www.planetree.org 


Dearest:   I thought that part of the Hippocratic Oath was putting the patient 
first.


Margaret A. Mahony MD:   We all need to be reminded of that. 


Dearest:   Seems sometimes among HMO's to be more the Hypocritic Oath.  
Kelly, your turn.


Kelly:   In my HMO, I have to call someone who will tell me if I can go to the 
emergency room or not.  Is there any way to change that? I don't think I should 
have to wait while someone on the phone decides if I can go or not.


Dearest:   Amazing


Kelly:   I know :(


Margaret A. Mahony MD:   The HMOs were an idea whose time has come and gone. It 
is time to do something else. 


Dearest:   A person could die while waiting for permission.


Margaret A. Mahony MD:   It is time to change. 


Kelly:   It scares me to have to do that. 


Margaret A. Mahony MD:   This is one of the corrections that is being addressed 
in the Patients Bill of Rights.


Kelly:   Good!  thanks :)


Dearest:   I gather you left the HMO with which you were associated? 


Margaret A. Mahony MD:   Yes. I could no longer participate in the system that 
was producing so much distress and angst for my patients. 


Dearest:   And now if a woman entering perimenopause comes to see you, she can 
expect to spend time talking and understanding the changes she's going through? 


Margaret A. Mahony MD:   Yes, all first visits are one hour as well as all 
yearly check ups. 


Dearest:   I had an HMO doctor tell me when I started this process, "I'm sorry, 
but I don't know much about menopause." I still pay for HMO coverage for 
emergencies, but I see my private doctors.  You're to be commended for leaving a 
system you knew was inherently bad for your patients.


Margaret A. Mahony MD:   You sound very much like how people are using their 
health coverage here.  You see, you are already acting like you have an MSA 
because that is how they work. People pay out of their tax-deferred account and 
have their catastrophic coverage for emergencies. 


Dearest:   Yes, I think that's exactly how I'm using it. Froggy, go 
ahead.


Froggy4:   We got new insurance at work.  We were required to sign that we would not 
sue either the insurance carrier or any of the medical providers.  We were told if you 
don't sign it, you don't get insurance.


Margaret A. Mahony MD:   I have never heard of any thing like that. Do you have 
a consumers advocacy organization either non-profit or at the state government 
level to check that with? 


Froggy4:   I will have to follow up on it.  Don't think ANY insurance should 
require that clause!   (I did sign it for now -- need insurance!)


Dearest:   Peggy, thank you for an informative and stimulating chat about the 
managed healthcare system. I hope you'll return so we can discuss more about 
women's health care and menopause in particular. I recommend Dr. Margaret A. 
Mahony's book, "Saving The Soul of Medicine." 

Peggy also has a Web site at http://www.menopausetreatment.com. 


Margaret A. Mahony MD:   Thank you for having me. I have enjoyed it. I would be 
delighted to join you again.



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Dearest
aka Alice Stamm
Power Surge
Founder, Facilitator, Host


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