Notes

1. Michael Shadid, M.D., Crusading Doctor, University of Oklahoma Press, 1991.

1. Kaiser Family Foundation/Harvard Public Opinion Survey, September 17, 1998.
2. Kaiser Family Foundation/Harvard National Survey of Americans' Views on Consumer Protection In Managed Care, January 21, 1998.
3. "Sick People in Managed Care Have Difficulty Getting Services and Treatment," Robert Wood Johnson Foundation, June 28, 1995.
4. Dr. John E. Ware, Journal of the American Medical Association, October 1,1996; Robert Pear, "Elderly and Poor Do Worse Under HMO Plans' Care," New York Times, Oct. 2, 1996.

1. Linda Peeno, "Managed Care Ethics: The Close View," U.S. House of Representatives Committee On Commerce, Subcommittee On Health and Environment, May 30, 1996.
2. Linda Peeno, Testimony to California Assembly Committee on Health, April 15, 1997.
3. Linda Peeno, "Managed Care Ethics: The Close View," U.S. House of Representatives Committee on Commerce, Subcommittee on Health and Environment, May 30, 1996.
4. Michael Fitzgerald, "Stockton MD Fed Up With HMOs," Stockton Record, May 29, 1998.
5. Letter, Cheryl Tannigawa, Director of Utilization Management, Harriman Jones Medical Group, Memo To M.D., October 11, 1989.
6. Peter Delevett, "Utilization Review Under The Scalpel," San Jose Business Journal, June 8, 1998.
7. Packevicz v. Mohawak Valley Medical Associates, United States District Court Northern District of New York, Complaint and Request For Injunctive and Other Relief. 98-CV-0835(FJS)(DNH).
8. The lawsuit argues that "community standards in the State of New York do not mandate slow, certain, miserable, hopeless, excruciating and inhumane death in plaintiff's case where there is a medically recommended reasonably feasible alternative a few dollars away." Is it really for an HMO or an individual to choose whether they live or die? The HMO, MVP, claimed the denial was based on a definition of community standard of medicine. When they violate that standard, isn't it medical negligence?
9. Renee Berman, Peter Berman v. Health Net, Los Angeles Superior Court, Case No. BC 139 875 Second Amended Complaint.
10. Erik Larson, "The Soul of An HMO," Time, January 22, 1996 p.52.
11. George Anders, Health Against Wealth, Houghton Mifflin, 1996, p.115; Nina Martin, "As Shock of Cancer Verdict Spreads," San Francisco Daily Journal, January 7, 1994.
12. Joyce Ramey v. Inter Valley Health Plan Inc., United States District Court Central District of California, Case No. CV 96-425 CBM (JGx) Binding Award of Arbitrator.
13. Anita Ostroff, Senior Counsel, Department of Corporations, Letter to Mr. Paul Brandes, Kaiser Foundation Health Plan, "Re Public Survey Report Kaiser Foundation Health Plan, Inc. Northern California Region," August 14, 1996, File No: 933-0055. pp. 6, 7.
14. Ibid.
15. Mark Silk, "$45 Million Malpractice Verdict; Fulton County Jury Award Against HMO Largest Ever In State," Atlanta Constitution, February 4, 1995, p. C10.
16. Julie Appleby, "$1 Million Fine Levied On Kaiser By Texas," Contra Costa Times, April 24, 1997.
17. Dawnelle Barris, etc, et al. v. County of Los Angeles, et al. Superior Court of the State of California for Los Angeles, Case No. TC 007062.
18. Karen Johnson v. Humana Health Plan Inc., Jefferson Circuit Court, Kentucky, No 96-CI-00462.
19. Kim Wessel, "Woman Wins Humana Suit," The Courier-Journal, Louisville, Kentucky, October 21, 1998, p. A1.
20. Estate of Glenn Nealy v. U.S. Healthcare, United States District Court for the Southern District of New York, order by Judge Charles Haight, March 2, 1994. Unfortunately for the Nealys, Glenn received his health benefits through his private sector employer. Under federal ERISA law (see Chapter Five), the only legal remedy available to an injured patient is the cost of the benefit delayed or denied. Susan Nealy cannot recover economic losses — such as lost wages or salary — or non-economic losses. Because Glenn never incurred any medical expenses, the managed care company cannot be held responsible for any costs and Susan Nealy has no remedy for the wrongful death of her husband. The District Court for the Southern District of New York had no choice but to dismiss Susan's claims for the breach of contract, misrepresentation and wrongful death.
21. Betty Carol Hale v. California Physicians Service dba Blue Shield of California, Superior Court of the State of California for the County of Los Angeles, Case No. BC 098790. Hale settled the complaint with Blue Shield and is limited by the agreement about what she can now say.
22. While the company employs doctors, Milliman's Internet site identifies the company as "Milliman & Robertson; Actuaries & Consultants" www.milliman-hmg.com/index.shtml.
23. Allen Myerson, "Helping Health Insurers Say No, Having a Caesarian? You Get 2 Days In the Hospital," New York Times, March 20, 1995, p. D1.
24. George Anders and Laurie McGinley, "Medical Cop: Actuarial Firm Helps Decide Just How Long You Spend In The Hospital," Wall Street Journal, June 15, 1998, p. A1.
25. Ibid.
26. Allen Myerson, "Helping Health Insurers Say No, Having a Caesarian? You Get 2 Days In the Hospital," New York Times, March 20, 1995.
27. John Vogt, MD, Director of Resource Management, "Inpatient Concurrent Management Systems, Kaiser Permanente Texas Region," December 3, 1995.
28. Thomas Self v. Children's Associated Medical Group, Superior Court of the State of California for the County of San Diego, Case No. 695870; Bill Callahan, "Doctor Wins Quality-of-care Lawsuit," San Diego Union Tribune, April 7, 1998; Julie Marquis, "Doctor Gets $2.5 Million Settlment," Los Angeles Times, April 28, 1998.
29. Linda Peeno, "Managed Care Ethics: The Close View," U.S. House of Representatives Committee on Commerce, Subcommittee on Health and Environment, May 30, 1996.
30. Milt Freudenheim, "Risky Business; A Set Fee For Each Patient Gives Doctors More Control and More of a Financial Stake," New York Times, May 30, 1998, p. D1.
31. Roni Rabin, "Blow To Managed Care? Ruling Backs LI Mom's Challenge Of Insurers Set Fees," Newsday, November 21, 1996.
32. Letter from Bruce Vladeck, The Administrator, United States Department of Health and Human Services Health Care Financing Administration, "To Dr. Gordon Schiff, Director of General Medicine Clinic, Department of Medicine, Cook County Hospital," October 31, 1994.
33. Milt Freudenheim, "Risky Business; A Set Fee For Each Patient Gives Doctors More Control and More of a Financial Stake," New York Times, May 30, 1998, p. D1.
34. Letter John M. Maggiano, MD, Orange County Retina Medical Group, To Jamie Court, "Re Dr. Self," April 8, 1998.
35. Internal Memo "From: Donald Drake, M.D., Medical Director, Greater Newport Physicians, Date: May 8, 1997, To: All GNP Physicians, Subject: Pharmacy Management."
36. Jay Greene, "Prescribing Tighter Purse Strings," Orange County Register, October 16, 1997.
37. "ABMG Physician Status Report October 1998."
38. "Health Net Out-Patient Rx Physician Prescribing Profile For: July 1, 1996–September 30, 1996"
39. Paul Elias, "Doctors Negligent In Woman's Cancer Death, Jury Finds," Los Angeles Times, November 16, 1995.
40. David Olmos, "Cutting Medical Costs — Or Corners?" Los Angeles Times, May 5, 1995.
41. John Hendren, "Sizable Health Care Cost Rise Seen," Associated Press, June 2, 1998.
42. Testimony of Dr. Troyen Brennan, Harvard School of Public Health, on "Medical Malpractice and Health Care Reform," before the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House Of Representatives, November 10, 1993, pp.6-7.
43. "Sick People in Managed Care Have Difficulty Getting Services and Treatment," Robert Wood Johnson Foundation, June 28, 1995.
44. Dr. John E. Ware, Journal of the American Medical Association, October 1,1996; Robert Pear, "Elderly and Poor Do Worse Under HMO Plans' Care," New York Times, October 2, 1996.
45. Kaiser Family Foundation/Harvard National Survey of Americans' Views on Consumer Protection In Managed Care, January 21, 1998.
46. Press Release, "Malpractice Reform Won't Have Much Effect On Defensive Medicine Costs," Office Of Technology Assessment, Congress of the United States, July 21, 1994.
47. Sharp HealthCare Employee Handbook, "Employee Quality & Development," October 1, 1995, pp. 42–43.
48. Rebecca Smith, "Doctors, nurses must take loyalty oaths, groups say," San Jose Mercury News, July 17, 1996.
49. Health Net Provider Service Agreement, p. 9, p. 12 rev. 1/95.
50. Alta Bates Employee Handbook, p. 23.
51. U.S. Healthcare Primary Care Physician Agreement, 6/94.
52. Foundation "VIP IPA" Participating Specialty Physician Agreement, p. 5.
53. METLIFE Health Care Network IPA Service Agreement, Simi Valley Family Practice Group, p. 18.

1. Kaiser Permanente Southern California Region, Business Plan, 1995-1997, p. 18.
2. This is but another form of fraud — price your product lower than it costs, then jack up the premium once you have the customers. The fact that a non-profit company — considered one of the better ones in the market — has sunk to these lows is a barometer of the widespread deception perpetrated against the American public.
3. Julie Appleby, "$1 Million Fine Levied On Kaiser By Texas," April 24, 1997; David Olmos, "Texas Regulators Assail Kaiser On Physicians, Care," Los Angeles Times, April 24, 1997.
4. Julie Appleby, "Kaiser Warned It May Lose Federal Funding," Contra Times, April 18, 1997.
5. Anita Ostroff, Senior Counsel, Department of Corporations, Letter to Mr. Paul Brandes, Kaiser Foundation Health Plan, "Re Public Survey Report Kaiser Foundation Health Plan, Inc. Northern California Region," August 14, 1996, File No: 933-0055.
6. "HOPE: For S.C.P.M.G. Physicians — Catalyzing the Exchange of Ideas Within S.C.P.M.G." Volume 3, No.6, June–August 1997. P.O. Box 121 Cerritos, CA 90701; Consumers For Quality Care Press Release, "Kaiser Physicians Angry," September 25, 1997.
7. Videotape, "Kaiser Permanente On The Air Finally…The Personalized Advertising Campaign."
8. IRS records acquired by California Nurses Association.
9. "HOPE: For S.C.P.M.G. Physicians — Catalyzing the Exchange of Ideals Within S.C.P.M.G." Volume 3, No. 6, June–August 1997. PO Box 121 Cerritos, CA 90701 — Consumers For Quality Care, "Kaiser Physicians Angry," September 25, 1997.
10. Ibid.
11. California Nurses Association, "Corporate Health Care: For-Profit, Not-for-Profit, or Not for Patients? Kaiser Permanente," December 1997.
12. Video tape, "Kaiser Permanente On The Air Finally…The Personalized Advertising Campaign."
13. David Olmos, "Early-Release Policy At HMOs Draws Fire: Kaiser Decision To Send Some Mothers And Newborns Home After Eight Hours Raises the Debate To A New Level," Los Angeles Times, June 16, 1995.
14. Associated Press, "Study Finds Big Savings In Early Discharge Following Childbirth," June 5, 1995.
15. Memo, Maternity Leave, "Positive Thoughts Regarding The Eight Hour Discharge," Harper's, February 1996.
16. Orange County Register, March 17, 1996.
17. Kaiser later claimed it stopped these bonuses tied to reduced hospital admissions in Southern California after the public outcry from the release of the business plan. Carl Hall, "Kaiser Dumps Bonus Plan," San Francisco Chronicle, December 20, 1995. The Northern California bonus system remained, according to the Chronicle article.
18. Video tape, "Kaiser Permanente On the Air Finally…The Personalized Advertising Campaign."
19. Ibid.
20. Ibid.
21. Ibid.
22. John Vogt, MD, Director of Resources Management, "Inpatient Concurrent Management Systems," Kaiser Permanente, Texas Region, December 3, 1995. The speech transcript was filed in a Texas lawsuit that Kaiser settled for $5.3 million. Ronald Henderson, of Irving Texas, died of a heart attack in 1995 after Kaiser allegedly provided inadequate care. Henderson's family claimed his death was due to Kaiser's cost-cutting. Charles Ornstein, "Kaiser Agrees To Pay $5.35 Million In Death," Dallas Morning News, December 17, 1997. p. A1.
23. Sabin Russell and Carl Hall, "Discord in Kaiser Health Empire," San Francisco Chronicle, February 16, 1996; Email, "TO: GIL.ALL.PHYSICIANS, SUBJECT: NO ON DR. CAUFIELD," January 29, 1996.
24. Adrian Broughton vs. CIGNA Healthplans of California, Court of Appeal No.2 Civ. B 093517 Los Angeles County Sup. Ct. No. BC 117680; K.Oanh Ha, "Lawsuit Seeks To Bypass HMO Arbitration Process," Wall Street Journal, California, Wednesday, September 10, 1997, p. CA2.
25. Sabin Russell, "HMO's Sales Method Sharply Criticized in S.F.," San Francisco Chronicle, November 30, 1994; Nina Siegal, "Door to door health care," San Francisco Bay Guardian, January 18, 1995.
26. Rochin v. Foundation Health Superior Court of the State of California for the County of Los Angeles, Case No. BC 125367, Complaints filed August 29, 1995 and April 6, 1995; "Medi-Cal Mom Charges Major HMO With Deceptive and Fraudulent Marketing Practices," April 6, 1995, Shernoff, Bidart, & Darras, Claremont, CA. The family settled its lawsuit.
27. David Olmos, "HMO Accused of Deceptive Marketing," Los Angeles Tims, February 2, 1995.
28. Fred Shulte and Jenni Bergal, "Florida's Medicaid HMOs: Profits from Pain: A Reprint of a five part series published December 11–15, 1994," The Sun Sentinel, Fort Lauderdale, FL; Yvonne Chui, "Ex-workers file suit against Foundation," Sacramento Bee, March 3, 1995.
29. Bettijane Levine, "Losing Patience," Los Angeles Times, July 9, 1997.
30. Anne Peterson, "Doctors Say Anorexics and Bulimics Starving For Care Under HMO Plans," Associated Press, California, May 4, 1998.
31. Vicky Que, National Public Radio's Morning Edition, September 1, 1998; The National Journal Group Inc., Health Line, September 1, 1998.
32. Tom Abate, "Agency Tells Kaiser It Must Cover Viagra," San Francisco Chronicle, January 1, 1999.
33. Foundation Health Marketing Manual; Claims in marketing materials. Title of Foundation Medi-Cal Marketing Manual: "Health Care At No Cost To You."
34. Pam Slater, "Prescription for Profits," Sacramento Bee, June 26, 1994.
35. Foundation VIP IPA Participating Specialty Physician Agreement.
36. Bill Alpert, "Foundation Health Corp: Reserve Judgment," Dow Jones Wire Service, January 2, 1996.
37. Los Angeles Times West Side, June 1, 1995; Los Angeles Times Insert February 8, 1999.
38. Jay Greene, "To Some, HMO Policies On Mental Illness Make Little Sense," Orange County Register, July 27, 1997. In the wake of the scandal, the company claims, however, that it has put an even more expensive drug, Zyprexia, on its formulary.
39. "Informed Health from Aetna Health Plans," advertisement on file with California Department of Corporations.
40. Letter From Dr. Thomas Reardon, MD, American Medical Association, To Richard Huber, CEO Aetna/U.S. Healthcare, February 24, 1998.
41. Charles Ornstein, "Morales Sues Six HMOs, Alleges Incentive Policies Threaten Care," Dallas Morning News, December 17, 1998.
42. American Medical Association Discussion Paper on Aetna/U.S. Healthcare Acquisition of Prudential Health Care, February 1999.
43. Advertisement on file with California Department of Corporations.
44. Letter from Bruce C. Vladeck, Administrator, Department of Health and Human Services, To Dr. Gordon Schiff, Department of Medicine, Cook County Hospital, October 31, 1994.
45. Source: California Medical Association, "Knox Keene Health Plan Expenditures Summary FY 1995–96," February 1997.
46. Advertisements on file with California Department of Corporations.
47. Joyce Ramey v. Inter Valley Health Plan, Inc. United States District Court Central District of California, Case No. CV 96-4245 CBM, Hon. John Trotter, Justice (Retired) Court Of Appeal, JAMS/ENDISPUTE, Orange, CA.
48. Joe Nicolson, "HMOs Sic Bad Ads On Elders — Report," New York Daily News, November 22, 1995, p. 55.
49. Ibid.
50. Milt Freudenheim, "Medicare HMOs To Trim Benefits For Elderly," New York Times, December 22, 1997, p. A1.
51. Robert Pear, "Government Says HMOs Misleading Medicare Recipients," New York Times, April 13, 1999.
52. Bob Rosenblatt, "US Overpaid HMOs $1 Billion, GAO Report Says," Los Angeles Times, February 26, 1997, p. D1.
53. U.S. General Accounting Office, "MEDICARE, Fewer and Lower Cost Beneficiaries With Chronic Conditions Enroll in HMOs," Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives, August 1997. "While only 6% of all new enrollees returned to FFS within six months, the rates ranged from 4.5% for beneficiaries without a chronic condition to 10.2% for those with two or more chronic conditions. Also, disenrollees who returned to FFS had substantially higher costs prior to enrollment compared to those who remained in their HMO. These data indicated that favorable selection still exists in California Medicare HMOs because they attract and retain the least costly beneficiaries in each health status group."
54. Eric Weissman, "GAO: High Turnover at Medicare HMOs," Modern Health Care Magazine, March 11, 1998.
55. Sandra Sobieraj, "Clinton Shows Hint of Distraction," Associated Press, October 8, 1998.
56. Robert Pear, "Clinton Plans To Intervene As HMOs Exit Medicare," New York Times, October 8, 1998, p. A28.
57. Robert Pear, "Government Says HMOs Misleading Medicare Recipients," New York Times, April 13, 1999
58. Remarks by President Bill Clinton at Health Care Event, The Roosevelt Room, The White House, Washington, D.C., October 8, 1998, 12:30 Eastern Time, Federal Information Systems Corporation, Federal News Service.
59. While the case is public record, Sarver currently cannot talk about her son's condition because of a confidentiality clause. Blue Shield's PPO is regulated as a managed care entity under the California Department of Corporations. Steven and Bradley Sarver v. Public Employees' Retirement System, Superior Court of the State of California for the County of Los Angeles, BC 096228.

1. Steven Andrew Olsen v. Sharp Rees-Stealy Medical Group, Superior Court of California County of San Diego, Case No. 666808.
2. The Olsens recovered damages in a confidential settlement from the medical group and primary care physician. A jury awarded damages against the employer of the admitting physician. Unfortunately, the jury-awarded damages were reduced by nearly $7 million due to a state-imposed cap on the pain and suffering of injured patients in California. (See Chapter Six.)
3. Testimony of Dr. Troyen Brennan, Harvard School of Public Health, on "Medical Malpractice and Health Care Reform," before the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives, November 10, 1993, pp. 6–7.
4. James C. Robinson, PhD, MPH, "Decline in Hospital Utilization and Cost Inflation Under Managed Care In California," Journal of the American Medical Association, October 2, 1996, Vol 276, No 13, p. 1060.
5. Lucette Lagnado, "Patients Give Hospitals Poor Score Card," Wall Street Journal, January 28, 1997, p. B1.
6. Ibid.
7. Ibid.
8. Medical malpractice deaths based on projections by various commentators of data compiled by the Harvard School of Public Health as part of a comprehensive study of medical malpractice, Harvard Medical Practice Study Group, Patients, Doctors, and Lawyers: Medical Injury, Malpractice Litigation and Patient Compensation In New York (Cambridge, Mass.:Harvard University, 1990).
9. James C. Robinson, PhD, MPH, "Decline in Hospital Utilization and Cost Inflation Under Managed Care In California," Journal of the American Medical Association, October 2, 1996, Vol 276, No 13, p. 1060.
10. National Conference of State Legislators, National Institute For Health http://dccps.nci.nih.gov/DCCPS/http://www.ncsl.org/programs/health/cancer.htm.
11. Ellen Goodman, "Is This Any Way to Run a Health Care System?" Boston Globe, November 17, 1996.
12. California Nurses Association Patient Watch Program Report, October 20, 1997, Mildren Henderson, Napa, CA.
13. James C. Robinson, PhD, MPH, "Decline in Hospital Utilization and Cost Inflation Under Managed Care In California," Journal of the American Medical Association, October 2, 1996, Vol 276, No 13, p. 1060.
14. Sabin Russell, "Hospital Released Patient With Knife In Belly," San Francisco Chronicle, September 13, 1996.
15. CBS News 60 Minutes, "HMO," Produced by Patti Hassler, October 1, 1995, Volume XXVIII Number 3.
16. Julie Marquis, "Lifeline of Nurses Thinning; As Hospitals Turn To Lesser-Skilled Aides, RNs Are Working Double-Time To Compensate," Los Angeles Times, August 4, 1998 p. A1
17. Ibid.
18. "Work Week: A Special News Report About Life On The Job — and Trends Taking Shape There," Wall Street Journal, Tuesday June 25, 1996.
19. Letter Of Agreement, "Kaiser Permanente Medical Care Program Northern California Region and H.C.W.U., Local 250, Member Focused Care Initiative (Excluding the Fresno Medical Center)," 1996.
20. Julie Marquis, "Lifeline of Nurses Thinning; As Hospitals Turn To Lesser-Skilled Aides, RNs Are Working Double-Time To Compensate," Los Angeles Times, August 4, 1998, p. A1.
21. Steve Twedt, "Hospital Care; The cost of cutting," Pittsburgh Post-Gazette, February 11, 1996.
22. Dolores Kong, "Nurses Say Patients Feeling the Pain of Staffing Cutbacks," Boston Globe, October 31, 1994.
23. Craig Rose, "Medic! Area Nurses Warn of Problems in the System," San Diego Union Tribune, April 1, 1996.
24. Ibid.
25. Don Kazak, "Hospital Cited by the State Again," Palo Alto Weekly, January 10, 1996.
26. Kathy Robertson, "Sutter Roseville Is Cited For Understaffing ICUs," Sacramento Business Journal, April 29, 1996.
27. Carol Benfell, "Kaiser Cited For Use Of Unlicensed Help," Santa Rosa Press Democrat, August 18, 1998.
28. California Nurses Association Press Release, "Third Citation For Kaiser in Operating Room Abuses," August 19, 1998.
29. Carol Benfell, "Kaiser Cited For Use Of Unlicensed Help," Santa Rosa Press Democrat, August 18, 1998.
30. Kurt Laumann, "How Restructuring Affects Patient Care," San Francisco Chronicle, April 5, 1995, Op-Ed on editorial page.
31. Ibid.
32. Judith Shindul-Rothchild, "The 1996 AJN Patient Care Survey Final Results," Boston College, November 1996.
33. Patricia Prescott, "Nursing: An Important Component Of Hospital Survival Under A Reformed Health Care System," Nursing Economics, July–August 1993,Vol. 11, No. 4.
34. Editorial, "Paper Pushers Don't Improve Medical Care, A Philadelphia Daily News Editorial," News & Record (Greensboro, NC), February 23, 1996.
35. Mercy Healthcare Sacramento, ‘To: Regional Leadership Council Date: July 8, 1998 Subject: Nursing Shortage/Recruitment Difficulties, From:Charlene Moore — Acting Emp Manager."
36. Barbara Gray, "What's Going On?" NurseWeek, February 12, 1998.
37. "Columbia/HCA Whistleblower Marc Gardner Predicts Company Will Be Hit With Three To Five Billion Dollar Fine, Then Will Be Folded Into Tenet," Corporate Crime Reporter, March 23, 1998.
38. Tom Philp, "Study: Doctor Hospital Use Falls Result of HMOs Tightening Strings," Sacramento Bee, June 5, 1997, p. B1.
39. Jeffrey Kaye, "Community Care — Part Two," NewsHour with Jim Lehrer, February 3, 1998.
40. Modern Health Care, May 20, 1996.
41. Jeffrey Kaye, "Community Care — Part One," NewsHour with Jim Lehrer, February 2, 1998.
42. CBS News, 60 Minutes, "Not For Profit Hospitals," October 27, 1996, Vol. XXVIII, No. 7.
43. Modern Health Care, November 4, 1996.
44. Jeffrey Kaye, "Community Care — Part Two," NewsHour with Jim Lehrer, February 3, 1998.
45. Ibid.
46. Hugh Downs, Barbara Walters, "Former Columbia/HCA Executive Speaks Out," ABC 20/20, September 26, 1997.
47. Ibid.
48. Modern Health Care, July 27, 1998, p. 26.
49. Kurt Eichenwald, "Health Care's Giant: Artful Accounting — A special report; Hospital Chain Cheated U.S. On Expenses, Documents Show," New York Times, December 18, 1997, p. A1.
50. Kurt Eichenwald, "Accounting Firm Is Named In Medicare Fraud Lawsuit," New York Times, May 29, 1999, p. B5.
51. Kurt Eichenwald, "Health Care's Giant: Artful Accounting — A special report; Hospital Chain Cheated U.S. On Expenses, Documents Show," New York Times, December 18, 1997, p. A1.
52. Marc Gardner, Corporate Crime Reporter, March 23, 1998.
53. Mike Wallace, CBS News 60 Minutes "Not For Profit Hospitals," October 27, 1996 Vol. XXVIII, No. 7.
54. Ibid.
55. Carl Ginsburg, "The Patient As Profit Center; Hospital Inc. Comes To Town," The Nation, November 18, 1996, p. 18.
56. Ibid.
57. Lucette Lagnado, "Ex-manager Describes The Profit-Driven Life Inside Columbia/HCA," Wall Street Journal, May 30, 1997, p. 1.
58. Bruce Japsen, "Columbia's Big Ad Bucks, Gain Chain Outspends Other Hospitals On Advertising," Modern Health Care, March 10, 1997, p. 2.
59. Carl Ginsburg, "The Patient As Profit Center; Hospital Inc. Comes To Town," The Nation, November 18, 1996, p. 20.
60. Lucette Lagnado, "Ex-manager Describes The Profit-Driven Life Inside Columbia/HCA," Wall Street Journal, May 30, 1997, p. 1.
61. Carl Ginsburg, "The Patient As Profit Center; Hospital Inc. Comes To Town," The Nation, November 18, 1996, p. 20.
62. Kurt Eichenwald, "Health Care's Giant: Artful Accounting — A special report; Hospital Chain Cheated U.S. On Expenses, Documents Show," New York Times, December 18, 1997, p. A1.
63. Sharon Bernstein, "Hospital Offers Apology for Denial of Epidural," Los Angeles Times, July 3, 1998.
64. Robert Pear, "Mothers on Medicaid Overcharged For Pain Relief," New York Times, March 8, 1999 p. A1.
65. Sharon Bernstein, "County C-Section Rule Took Heavy Toll," Los Angeles Times, January 25, 1998.
66. Abraham Verghese, "My Hospital, Dying a Slow Death," New York Times, November 30, 1996, p. 19.
67. Chuck Idelson, California Nurses Association study, 1996.
68. "Tenet To Buy Two HCA Hospitals," Associated Press, Monday June 22, 1998.
69. Lucette Lagnado, "Ex-manager Describes The Profit-Driven Life Inside Columbia/HCA," Wall Street Journal, May 30, 1997, p. 1.
70. Nancy McVicar and Ellen Forman "Tenet Hospitals Under Federal Investigation; Officials, Physicians at North Ridge Subpoenaed," Fort Lauderdale, Sun Sentinel, May 20, 1998.
71. Phil Galewitz, "Ontario Sues Tenet Healthcare, Two County Hospitals," Palm Beach Post, May 9, 1997.
72. Kurt Eichenwald, "$100 Million Settlement Seen In Tenet Suits," July 30, 1998, p. D1; David Olmos, "Tenet: To Settle Claims of 700 Former Patients," Los Angeles Times, July 31, 1997.
73. Paul Clegg, "Health Care Ties That Bind: Religious Control Often Ends Reproductive Services," Sacramento Bee, July 18, 1998.
74. Ibid.
75. Ibid.
76. Valeria Godines, "San Bernardino Hospital Accepts Merger Proposal: Independent Joins Catholic Healthcare West," Riverside Press-Enterprise, August 15, 1998.
77. Ibid.
78. Paul Clegg, "Health Care Ties That Bind: Religious Control Often Ends Reproductive Services," Sacramento Bee, July 18, 1998.
79. Rick Wartzman, "Hospitals Start To Look A Lot More Like HMOs," Wall Street Journal, California Edition, August 27, 1997.
80. Modern Health Care annual report on multi-unit hospital systems for 1997, May 25, 1998.

1. Jennifer Steinhauer, "Sharpest Health Insurance Increases Hit Small Employees the Hardest," New York Times, January 9, 1999, p. A21; Sharon Bernstein, "CalPERS To Let Health Rates Rise 10%," Los Angeles Times, May 19, 1999, p. C1; David Hilzenrath, "Big HMO Rate Rise To Hit Older Americans," Washington Post, October 25, 1998.
2. Milt Freudenheim, "Humana Finds That The Going Gets Tougher," New York Times, April 9, 1999.
3. Sharon Bernstein, Alissa Rubin, Robert Rosenblatt, "An Rx For Disaster," Los Angeles Times, March 28, 1999, p. C1.
4. Cited in Opening Statement of Rep. Pete Stark, Medicare-Choice Ways and Means Health Subcommittee Hearing, March 18, 1999.
5. Ibid.
6. Ibid.
7. Summary, Dissenting Views of Senator Jay Rockefeller, Rep. John D. Dingell, Rep. Jim McDermott on the Bipartisan Commision on the Future of Medicare, March 16, 1999, p. 8.
8. Ibid at page 8, Citing National Academy of Social Insurance, Medicare and the American Social Contract, February 1999, p. 26.
9. California Medical Association, "Knox-Keene Health Plan Expenditure Summary FY 1995–1996" & "FY 1996–1997"; Corporate Research Group — Outlook for Managed Care 1997, Woolhandler and Himmelstein, New England Journal of Medicine, May 2, 1991; 324:1253.
10. Kathy Robertson, "Individual Health Plan Rates Leap," Sacramento Business Journal, August 24, 1998.
11. CIGNA Preferred Provider option; inter alia.
12. Frank McArdle PhD., Hewitt Associates, presentation "On Employer-Provided Retiree Health Benefits" to the Bipartisan Commission On The Future Of Medicare, July 14, 1998, Cited in Summary, Dissenting Views of Senator Jay Rockefeller, Rep. John D. Dingell, Rep. Jim McDermott on the Bipartisan Commision on the Future of Medicare, March 16, 1999, p. 9.
13. USA Today, July 15, 1998 citing Henry J. Kaiser Foundation charts. Peter T. Kilborn, "Reality of HMO System Does Not Live up to the Dream," New York Times, October 5, 1998, p. A2. Ronald Brownstein, "Budding Children's Health Program Could Seed Low-Income Adult Care," Los Angeles Times, February 22, 1999, p. A5.
14. Ron Winslow and Leslie Scism, "Aetna Agrees to Acquire U.S. Healthcare," Wall Street Journal, April 2, 1996, p. A2; Associated Press, "U.S. Healthcare Chief Will Get $1 Billion," June 15, 1996.
15. Managed Health Care Market Report 1/31/97, 7/15/97 cited in Center for National Health Program Studies, "For Our Patients, Not for Profit: A Call To Action," Chartbook and Slideshow, 1998 edition by Steffie Woolhandler and David Himmelstein.
16. Ron Pollack & Lorie Slass, "Premium Pay II: Corporate Compensation on America's HMOs," Families USA, September 1998.
17. Forbes, May 18, 1998.
18. George Anders, Health Against Wealth, Houghton-Mifflin, 1995, p. 73.
19. Modern Health Care, February 12, 1996, p. 126.
20. New England Journal of Medicine, 1997, 336:1828 cited in Center for National Health Studies, Chartbook 1998, p. 128.
21. The Crystal Report Online on Executive Compensation, "The Flap over HMO/Health Care CEO Pay Premiums," February 1999; Bloomberg News, "HMO Execs Among Highest Paid, Study Says," Los Angeles Times, December 10, 1998, p. C3.
22. Don DeMoro, "Abdicating Health Care Policy to the Market," Institute for Health and Socio Economic Policy, Oakland, CA, April 1996, p. 7.
23. Ibid, p. 8.
24. Dr. Eli Ginsburg, "The Uncertain Future Of Managed Care," New England Journal of Medicine, January 14, 1999.
25. Discussions with Dr. Robert Gumbiner, September 1997 at his home in Long Beach, California. See also Gumbiner's FHP: The Evolution Of A Managed Care Health Maintenance Organization 1993–1997, Volume II, An Oral History, University of California, Berkeley.
26. FHP: The Evolution Of A Managed Care Health Maintenance Organization 1993–1997, Volume II, An Oral History, University of California, Berkeley. p. 14, 21.
27. The case has been dismissed due to pleading deficiencies and is now on appeal.
28. George Anders, "HMOs Pile Up Billions In Cash," Wall Street Journal, December 21, 1994, p. A1.
29. Milt Freudenheim "Concerns Rising About Mergers," New York Times, January 13, 1999, p. 1.
30. "Industry News & Trends," Health Care PR and Marketing News, May 30, 1996, Vol. 5, No. 11.
31. California Medical Association, Testimony at PacifiCare/FHP merger hearing at Irvine Civic Center, June 29, 1997.
32. Joseph Nocera, "The Tarnished Darlings of Wall Street," New York Times, January 4, 1998, sec. 4, p. 11.
33. Bloomberg News, "Aetna Profit Up 15%," Los Angeles Times, April 29, 1999; "PacifiCare 1st Quarter Profits Up 79%" Los Angeles Times, May 6, 1999.
34. Sharon Bernstein, "Much Of Ailing MedPartners Unregulated, State Says; Health Care: Company Takes Court Action To Overturn Department Of Corporations Takeover," Los Angeles Times, March 18, 1999.
35. Michael Schrage "Are HMOs Too Big To Go Bust?" Los Angeles Times, February 11, 1996, p. D2.
36. Wall Street Journal Texas Edition, March 31,1999 — cited in Health Line, National Journal Group, March 31, 1999.
37. David R. Olmos, "As Cutbacks Hit Limit, Health Costs Rise Anew," Los Angeles Times, April 16, 1997, p. A1.
38. Milt Freudenheim, "Concern Rising About Mergers in Health Plans," New York Times, January 13, 1999, p. A1.
39. U.S. News Online, September 23, 1998, www.usnes.com/usnews/nycu/health-/hetophmo.htm.
40. David R. Olmos, "Survey Ranks PacifiCare and Health Net Best HMOs in State," Los Angeles Times, June 24, 1998, p. D1.
41. St. Petersburg Times, July 25, 1998; Healthline April 7, 1998, National Journal Group, reporting on Albany Times Union article that day.
42. Milt Freudenheim, "Insurers Moving To Limit Doctors’ Contract Choices," New York Times, February 8, 1999, p. A14.
43. Charles Ornstein, "States target all-or-none health-care pacts," The Dallas Morning News, March 15, 1999, p. D1.
44. Stuart Silverstein and Davan Maharaj, "Health Care Industry’s Fiscal Crisis Creates Turmoil For Insured Patients; Medicine: Bankruptcies And Other Changes Shift Consumers Into New Programs. The Switch In Care Can Bring Disruptions And Discomfort," Los Angeles Times, March 28, 1999.
45. Roni Rabin, "Blow to Managed Care?" Newsday, November 21, 1996, p. A26.
46. Stuart Silverstein and Davan Maharaj, "Health Care Industry’s Fiscal Crisis Creates Turmoil For Insured Patients; Medicine: Bankruptcies And Other Changes Shift Consumers Into New Programs. The Switch In Care Can Bring Disruptions And Discomfort," Los Angeles Times, March 28, 1999.
47. Ibid.
48. Milt Freudenheim, "Concern Rising About Mergers in Health Plans," New York Times, January 13, 1999, p. A1.
49. Frank Browning, "Future of Managed Care in America," National Public Radio, March 1, 1999, interview.
50. Allen Meyerson, "A Double Standard For Health Coverage," New York Times, March 17, 1996.
51. New York Times, January 13, 1999, Ibid.
52. Sheryl Gay Stolberg "Managed Care Squeezes Research Funds and Charity Health Aid, Studies Find," New York Times, March 24, 1999, p. A20.
53. Harvey Shapiro, MD, Managed Care Beware, Dove Books, 1998, p. 184.
54. Commonwealth Fund Release 199, February 1999.
55. Bob Herbert, "Hospitals In Crisis," New York Times, April 15, 1999.
56. Ibid.
57. Amy Goldstein, "U.S. Will Pay To Reduce Doctor Glut; Teaching Hospitals That Shrink Programs To Receive Millions," Washington Post, August 24, 1997, p. A1. Is the medical market really free? "I don’t know where the hell a Republican Congress gets off doing labor force planning for the medical profession," said Robert E. Moffit, deputy director for domestic policy studies at the conservative Heritage Foundation. "As an economic principle it is absurd."
58. The Dallas Morning News, November 28, 1998, p. 1.
59. Journal of the American Medical Association, December 23/30, 1998, Vol. 280, No. 24, p. 2060.

1. Corcoran v. United Healthcare Inc, 965 F.2d 1321 (5th Cir 1992).
2. The Court held, "State common law causes of action arising from the improper processing of a claim are preeempted." Pilot Life Insurance v. Dedeaux, 481 U.S. 44 (1987) ERISA’s preemption clause supercedes state law relating to employer-employer benefits if that law is not specifically regulation of the business of insurance. The company lawyers argued that state common law was not technically the business of insurance and therefore not specifically "saved" from preemption by ERISA’s savings clause which protects state regulation of insurance.
3. Dishman v UNUM, CV 96-0015 JSL Central Almanac, Vol. III, No. 4, 6/2/1997. pp. 3–6, 15–17.
4. Andrews-Clark v Travelers Insurance Co., 1997 US Dist. LEXIS 17390,21 E.B.C.2137 (D Mass1997). Robert Pear, "Hands Tied, Judges Rue Law That Limits HMO Liability," New York Times, June 11, 1998.
5. The evidence was under a protective order, that has since been lifted, in Richard Fisher v. Aetna Life Insurance Co., No. 3AN97-291, Alaska Super, Anchorage.
6. Laura Meckler, "Advocates Hope Video Will Jump Start Debate," Associated Press, October 13, 1998.
7. Fisher transcript, p. 16, court reporter corrected.
8. Fisher transcript, p. 16–17, court reporter corrected.
9. Fisher transcript at p. 58; Also see Dan Weintraub, "Tale of Aetna tape: fear of suit a factor in health claim reviews," Orange County Register, October 25, 1998, p. A4. Weintraub reports, "The tape captures a group of insurance company’s lawyers sitting at a long table in what looks like a hotel conference room rustling papers and sipping from water glasses as they tell the workers who process disability insurance claims to give extra attention to cases involving people who can take them to court and collect such damages. Here’s the gist: The company won’t deny a claim from someone who can sue for damages unless the firm first conducted a ‘reasonable investigation’ of the case. But other claimants can be denied benefits after only a cursory review."
10. Fisher transcript, p. 59 — court reporter corrected.
11. Weintraub, p. A04.
12. Jane Bryant Quinn, "You Deserve the Right to Sue Greedy Insurers that Unreasonably Deny Health, Disability Claims," Buffalo News, November 22, 1998, Business section, p. 13B.
13. Fisher transcript, p. 52 court reporter corrected.
14. Trial testimony of Bryan Southall, Ace v. Aetna Life Insurance Co., J94-018 Civil (JWS). Southall testified that Aetna’s "Proper Claim Handling Guidelines" had been removed from its Methods and Procedures Manual.
15. Deposition excerpt from Judy Talley in Fisher v. Aetna Life Insurance Co., 3AN 97-291 Civil (Superior Court, State of Alaska, Third Judicial District at Anchorage).
16. Fisher transcript, p. 43.
17. Fisher transcript, p. 56–57 — court reporter corrected.
18. Much effort went into making it public. Congressman Lloyd Dogget — a former Justice on the Texas Supreme Court — wrote the judge in July 1998 to successfully break the seal on the evidence presented in this case. Dogget wrote, "The Congress is now grappling with the unintended consequences of ERISA, namely the legal immunity this federal law provides to insurers who wrongully delay or deny medical care to patients covered under ERISA plans…the Congess is in critical need of information relating to the manner in which insurers process and/or resolve claims filed by patients covered under both ERISA and non-ERISA plans…Specifically, Members of Congress are seeking information that helps to explain how, and why, insurers process ERISA and non-ERISA cases differently."
19. Kenneth Reich, "An Equal Chance/Wrestling With The Unmanageable Side Of Health Care," Los Angeles Times, September 24, 1998, p. B5.
20. Cannon v. Group Health, 77F.3d (10th circuit) 1996.
21. Robert Pear, "Move Under Way To Try To Slow Health Care Bills," November 4, 1997, p. A1.
22. Charlie Norwood, "Protection For Patients," Washington Post Op-Ed, February 18, 1998.
23. Coopers & Lybrand L.L.P., "Impact Of Potential Changes To ERISA," Kaiser Family Foundation, Menlo Park, CA, June 1998.
24. Congressional Budget Office Cost Estimate, "H.R. 3605/S. 1860," July 16, 1998.
25. Bush allowed the bill, SB 386, to become law without his signature.
26. Corporate Health Insurance Inc., Aetna Health Plans of Texas Inc. v. Texas Department of Insurance, United States Court for the Southern District of Texas, Houston Division, Civil Action No. H-97-2072 Order. By contrast, the Court struck down the HMO-backed independent review process as preempted by ERISA — because it deals with determinations of coverage disputes. The review process is the HMO industry’s suggested alternative to liability.
27. Letter from Texas State Senator David Sibley, The Texas Senate Economic Development Committee, to California Legislators, "RE: California Assembly Bill 2436 (Figueroa) — Support," June 24, 1998. Regarding imposing a medical malpractice compensation cap on liability, the Republican writes; "In Texas, civil liability for damages of a ‘physician or health care provider’ is limited…akin to California’s Medical Injury Compensation Reform Act or MICRA. For the purposes of SB 386 [the Texas HMO liability law], however, we determined that managed care companies should not be treated any differently than other profit-making business enterprises that are subject to liability under traditional tort laws. Because HMOs and managed care companies (including doctor-run medical groups) often apply a financial filter to determine treatment denials, their liability must not be artificially limited by a compensation cap. Such restricted responsibility would mitigate against approval of the most expensive treatment, such as cancer care. Under the Texas law, physician-run medical groups are considered managed care entities and do not fall under the compensation cap applicable to sole practitioners."
28. Carol Marie Cropper, "In Texas, a Laboratory Test on the Effects of Suing HMOs," New York Times, September 13, 1998, Section 3, p. 1.
29. Source: Penn, Schoen & Berland For American Psychological Association "Support For Right to Sue," USA Today, June 23, 1998.
30. Michael A. Hiltzik and David R. Olmos, "Kaiser Justice System’s Fairness Questioned," Los Angeles Times, August 30, 1995.
31. Nida Engalla et al. v. The Permanente Medical Group, Inc., Petitioners’ Opening Brief, No. SO48811 in the California Supreme Court, 1995.
32. Declaration of Michael Sullivan, Nida Engalla et al. v. Kaiser Foundation Hospitals, et al., Superior Court of the State of California, Alameda, No. H-15596-4.
33. Interoffice Memorandum "To Michael Hawkins From: Paul Fox Esq. Subject: December 5, 1995 Senate Insurance Committee Hearings," December 4, 1995; Exhibit in Engalla Case.
34. Bob Egelko, Associated Press, "Family May Sue Kaiser; High Court Says HMO Stalled Arbitration Over Dying Patient," San Jose Mercury News, July 1, 1997. p. 3B.
35. Linda Ross, Testimony before the California State Senate Judiciary Committee Interim Hearing, October 1995; see also Nancy Peverini, "ADR: A panacea for the civil justice system? Let’s take a closer look," Docket, October 1995. Peverini is counsel for Consumer Attorneys of California.
36. American Arbitration Association Commercial Arbitration Rules pamphlet cited by Peverini, Ibid.
37. Michael A. Hiltzik and David Olmos, "Kaiser’s Justice System’s Fairness Is Questioned," Los Angeles Times, August 30, 1995.
38. Ibid, also Ken Sigelman, Testimony before California State Senate Judiciary Committee Interim Hearing, October, 1995.
39. Reynolds Holding, "Letting Patients Choose How to Air Their Beefs," San Francisco Chronicle, July 26, 1998; Margaret Jacobs, "Group Won’t Arbitrate Patients’ Disputes," Wall Street Journal, July 1, 1998.
40. Olsen vs. Sharp Rees-Steely Medical Group et al. (San Diego Superior Court, Case No. 666808).
41. Letters to the Editor, San Diego Union Tribune, May 20, 1995.
42. The following twenty states appear to have caps on non-economic damages as noted: Alaska ($500,000), Colorado ($250,000), Hawaii ($375,000), Idaho ($468,000 adjusted for inflation), Indiana ($750,000 total damages), Maryland ($454,000 adjusted for inflation), Massachusetts ($500,000), Michigan ($500,000), Missouri ($516,000), Montana ($250,000), New Mexico ($600,00 total damages), North Dakota ($500,000), Ohio ($500,000 total damages), Oregon ($500,000), South Dakota ($500,000), Texas ($1.321 million adjusted for inflation), Utah ($250,000), Virginia ($1,000,000), West Virginia ($1,000,000), and Wisconsin ($383,000 adjusted for inflation). Compiled by California Assembly Judiciary Committee, May 1999, in analysis of AB 1380.
43. Proposition 103 Enforcement Project, "MICRA: The Impact On Health Care Costs Of California’s Experiment With Restrictions On Medical Malpractice Lawsuits," Santa Monica, CA, April, 1995.
44. Ibid.
45. Projections by study authors based on data compiled by the Harvard School of Public Health as part of a comprehensive study of medical malpractice, Harvard Medical Malpractice Study Group, Patients Doctors, and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York, (Cambridge, Mass.: Harvard University, 1990).
46. Letter from Texas State Senator David Sibley, The Texas Senate Economic Development Committee, to California Legislators, "RE: California Assembly Bill 2436 (Figueroa) — Support," June 24, 1998.
47. Maura Dolan, "Ruling Limits Damages In Girl’s Death At Hospital," Los Angeles Times, March 26, 1999.
48. Testimony of Dr. Troyen Brennan, Harvard School of Public Health, on "Medical Malpractice and Health Care Reform" before the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives, November 10, 1993, p. 9.

1. Susan Kelleher & Jay Greeene, "Man Calls Risperdal His Miracle Drug," Orange County Register, February 10, 1997. Following the fallout, PacifiCare now claims that that it has put Zyprexa on its formulary, which is more expensive than Risperdal.
2. Sabin Russell, "Drug Firm Plan Would Pay HMO To Favor 5 of Its Medications," San Francisco Chronicle, September 25, 1998, p. A1.
3. Peter Kilborn, "Reality of the H.M.O. System Doesn’t Live Up to the Dream," New York Times, October 5, 1998, p. A1; The Times points out that in the newspaper’s July 1998 poll "85% of respondents said the health care system needs fundamental change, barely below the 90% who said the same thing in a Times/CBS News poll in 1994 before the Clinton health plan died. Although 68% said they were satisfied with the quality of their family’s health care, 30% said they were not, up from 19% in 1994. And the percentage dissatisfied with the cost of health care was practically unchanged, 46% now compared with 47% then."
4. News at Deadline, Modern Health Care, February 10, 1997, Late News, p. 4. The 165 executives were polled while attending the Health Care Forecast Conference at the University of California-Irvine Graduate School of Management in February 1997.
5. Late News, Modern Health Care, Crane Communications Inc., March 16, 1998, p. 4.
6. Kaiser Family Foundation/Harvard American Small Business Alliance, "National Survey of Small Business Executives on Health Care," June 17, 1998. Menlo Park, California.
7. Sabin Russell, "Drug Firm Plan Would Pay HMO To Favor 5 of Its Medications," San Francisco Chronicle, September 25, 1998, p. A1 — Russell adds about the proportions of the problem "There are currently more than 100 Pharmacy Benefit Management companies, but an estimated 80% of the business is controlled by five companies that are either owned by or allied with pharmaceutical companies. Close ties between drug makers and formulary companies have attracted the attention of the Federal Trade Commission, which is concerned that such alliances could violate antitrust laws. Last month, pharmaceutical giant Merck & Co. signed an FTC consent agreement governing its relationship to Merck-Medco Managed Care, the nation’s largest pharmacy benefits management company, which it bought in 1993 for $6.6 billion. The agreement requires that Merck-Medco set up an independent committee of doctor and academic experts to determine which drugs will be on its formulary."
8. "Remarks by Vice President Al Gore at Event in Recognition of the Budget Agreement, The Rose Garden, The White House, Washington, D.C." Federal News Service, October 16, 1998, Friday, 12:30 Eastern Time, White House Briefing Transcript By: Federal News Service, 620 National Press Building, Washington, D.C. 20045.
9. Peter Kilborn, "Complaints About HMOs Rise As Awareness Grows," New York Times, October 11, 1998.
10. Congressional Budget Office Cost Estimate, "H.R. 3605/S. 1890, Patients’ Bill of Rights Act of 1998," July 15, 1998.
11. Corporate Health Insurance Inc. et al v. Texas Department of Insurance, U.S. District Court For the Southern District of Texas Houston Division, Civil Action No. H-97-2072 Order. The scope of the law, however, is limited — not addressing denials of coverage.
12. California State Senate Bill 21, authored by Senator Liz Figueroa and sponsored by the Foundation For Taxpayer and Consumer Rights, introduced in December 1998, www.sen.ca.gov.
13. Case law suggests it should be a public corporation, like a state bar association, rather than a private corporation, which some courts say state governments cannot create.
14. Ottawa Citizen, Dec. 12, 1995 and conversation with consumer advocate Ralph Nader.
15. See Chapter Four.
16. David Hilzenrath, "Big HMO Rate Rise To Hit Older Americans," Washington Post, October 25, 1998.
17. California Proposition 103, written by consumer advocate Harvey Rosenfield and approved by California voters in 1988 to reform the property-casualty insurance industry, instituted a "prior approval" system, which requires that any rate increases must first be approved by an elected insurance commissioner. Prior to the passage of Proposition 103, auto insurance rates in California had been rising 11% every year. Since 103’s passage, auto rates have declined approximately 1% per year during the last five years, the only state to see such decreases.
18. California Assembly Bill 322 (Figueroa, D-Freemont) in 1998 and Assembly Bill 794 in 1997.
19. See New England Journal of Medicine, Vol. 335, No. 13, September 26, 1996, p. 9995 as cited by former United States Justice Department attorney Kenneth C. Anderson, "Collusive Behavior In the Managed Health Care Industry," September 10, 1997 on behalf of the National Coalition of Mental Health Professionals and Consumers and the Alliance for Universal Access to Psychotherapy, 1200 G. Street NW, Suite 200, Washington, D.C. 20005 p. 23.
20. Kenneth C. Anderson in his paper "Collusive Behavior In the Managed Health Care Industry," September 10, 1997 on behalf of the National Coalition of Mental Health Professionals and Consumers and the Alliance for Universal Access to Psychotherapy, 1200 G. Street NW, Suite 200, Washington, DC 20005, p. 25.
21. Ibid.
22. Gina Kolata, "When Patients’ Records Are Commodities For Sale," New York Times, November 15, 1995.
23. Christine Gorman, "Who’s Looking At Your Files?" Time, May 6, 1996.
24. David R. Olmos and Shari Roan, "HMO ‘Gag Clauses’ on Doctors Spur Protest," Los Angeles Times, April 14, 1996. On the "Donahue" show, David Himmelstein, MD, criticized U.S. Healthcare and other HMOs for rewarding doctors for denying needed care and forcing them to sign contracts pledging not to disparage the HMO. When he was dropped three days later by U.S. Healthcare, he wasn’t surprised. "Every doctor who works with an HMO knows you are in trouble if you criticize," said Himmelstein.
25. Rick Weiss, "Aging: New Answers To Old Questions," National Geographic, November 1997, p. 12.
26. Consumer Reports, October 1998.
27. U.S. Department of Health & Human Services, 1988.
28. California Consumer Guide to Long-term Care, California Dept. of Aging, 1996.
29. John Baldwin, C. Everett Koop, "Search for the Cure," Washington Post Op-Ed, May 6, 1999.
30. Richard Knox, "HMOs’ Creator Urges Reform In Quality Care," Boston Globe, May 2, 1999.
31. Wyatt Andrews, CBS Evening News with Dan Rather: Libertyville, Illinois Friday, October 30, 1998, 08:04 PM ET.
32. Nancy Ann Jeffrey, "Aetna To Set Reviews For HMO Coverage Disputes," Wall Street Journal, January 12, 1999.
33. Robert Pear, "Americans Lacking Health Insurance Put At 16%," New York Times, September 26, 1998, p. A1.
34. Richard Knox, "HMOs’ Creator Urges Reform In Quality Care," Boston Globe, May 2, 1999.
35. Jennifer Steinhauer, "For the Medically Uninsured, Tough and Creative Choices," New York Times, "March 2, 1999, p. A1.
36. James Barba, "Medically Uninsured Still Cost Taxpayers," Letter to the Editor, New York Times, September 30, 1998.
37. Carl Weber, MD, "Managed Care Plans Shirk Their Duty," New York Times, Letters to the Editor, October 11, 1998.
38. The government is the single "payer."
39. Henry J. Kaiser Family Foundation, February 1998, Menlo Park, California; American Hospital Publishing Hospital and Health News, "Blue Skies or Black Eyes," April 20, 1998.
40. Alan Sager and Deborah Socolar, "If ‘Single Payer’ Is Our Best Slogan Should We Be Surprised That We Are Losing," American Public Health Association, November 18, 1996; Also see Alan Sager, Deborah Socolar, David Ford and Robert Brand, "More Care, At Less Cost," Boston Globe, April 25, 1999.
41. Richard Knox, "HMOs’ Creator Urges Reform In Quality Care," Boston Globe, May 2, 1999.
42. Dolorus King, "State Medical Society Gives Boost To Single Payer Health Plan Backers," Boston Globe, May 8, 1999, p. B3.
43. Sharon Bernstein, "ER Patients Lose In Specialists’ Rebellion," Los Angeles Times, June 1, 1999, p. A1.