Page 25 - Like No Business I Know

Hypocritical Oaths

responsibility to our parent company, Triskelion Inc. Our enterprise
is but one of three; the others, Triskelion Health Care and the
Triskelion Foundation, work synergistically with us to maintain an
acceptable level of profitability for our shareholders. You are familiar
with the other branches of this corporation, I assume?”
“Uh, I know they exist, but I’m a medical researcher, not a
businessman, Mr. Raven. What does that have to do with this crisis?”
“Be patient, Dr. Dreyfus, and hear me out. Your future depends
on it. Triskelion began fifteen years ago as a small for-profit health
maintenance organization. At that time the demand was great for a
medical services delivery system which could put a lid on escalating
costs. HMO’s did just that, providing corporate America with an
alternative to expensive private doctors, pharmacies and hospitals.
Care was both rationalized and rationed, assuring that every patient
but the most vocal would get bogged down in bureaucracy before
incurring excessive expense. The justification, expressed as the
ultimately lower cost of maintaining health compared to treating
illness, was accepted both by those forced to use HMO’s and the
dwindling number of government overseers of medical care.
Enrollment went up, and with it profits. This much even a non-
economist should be able to understand.”
“Well, yes, but—”
Raven categorically dismissed objections with an impatient gesture.
“One thing led to another. Smaller HMO’s were gobbled up by
larger ones. Nonprofit HMO’s converted to for-profit. The increase
in competition was offset by mushrooming demand. Economies of
scale driven by capitation meant profits could continue to rise. The
poor, the weak, the sickly—all were excluded wherever possible,
turned away by gatekeepers or the rising cost of enrollment. HMO’s
have become a very big business in this country, Dr. Dreyfus.
Triskelion is one of the major players, and its management saw
something coming down the road: demand could not keep pace. The
market would be saturated once every available more-or-less able-
bodied person signed up. Then the shake-out would occur: any
HMO spending more than the minimum on its enrollees would face
extinction. But the analysis of demand was subtler than that: taking
into account demographics—the passage of the baby-boom
generation—and revised life expectancy tables, our actuaries

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