Iowa Medicaid managed care clinics threaten doctor-patient relationships

Just when I thought I'd reached the saturation point of outrage over Gov. Terry Branstad's idea of turning over the health care of 560,000 vulnerable Iowans to out-of-state, for-profit companies, Iowa's three managed care companies - Amerigroup, Amerihealth and UnitedHealthcare - have announced a chilling new idea.

Clinics and 'wellness centers” will be set up in Des Moines, Cedar Rapids and Sioux City with catchy names like Team M.D. and Care More. These centers will be staffed by primary care physicians, nurses and 'extenders” who are employed by the for-profit managed care companies.

This puts medical personnel, who are obliged to care for patients, in direct exposure to the companies who hold the purse strings to health care funds.

Put yourself in the position of a physician at one of these clinics. You have examined a patient and determined that further medical attention is needed. In your professional opinion, this patient needs to be evaluated by a specialist.

You follow your ethical medical direction for the best, most effective treatment plan. Your employer - the for-profit managed care company who holds the state's dollars, disagrees.

Perhaps the company already has spent a considerable sum on tests. Perhaps further medical service would drastically cut into the company's (your employer's) profit margin.

For whatever reason, the referral is denied. In fact, if you keep up this type of expensive care, you might not be employed much longer at the clinic.

This is not complicated. These clinics place medical practitioners in direct conflict with the people who employ them, and threaten to sabatoge the entire foundation of the physician-patient relationship. Physicians and all medical personnel are obliged to provide advocacy for their patients. If that role of advocate is erased by a profit motive, the entire spectrum of health care in this state has been not only compromised but thrown in the gutter.

And all for the benefit of companies who have serious integrity issues. One can only pray that the legislative approved oversight committee has real power.

' Daniel Langfield, a member of The Gazette Writers Circle, was Director of the Linn County Medical Society for 17 years and a consultant to the Iowa City Mercy Hospital medical staff for 28 years. Comments: (319) 378-1027.