Page 64 - Just Deserts

TotalCare

rational, that allocation would probably be sufficient. But we must
take every subscriber who qualifies, without regard to prior
condition, and most people in our country are susceptible to a vast
array of preventable diseases—owing to poor diet, lack of exercise,
environmental pollutants, stress and abuse on the job and in the
family. This provides the statistician with a significant sampling of
who gets treated for what, by which methods and with what success.
Downloading that medical history along with line item expenditure
detail, we can use our software to discover unrecognized
relationships between variables.’
She referred to her printout.
“The beauty of this new computer technique is that, like linear
programming, you can both find optimal solutions to interrelated
variables and play ‘what-if’ by altering those variables—assuming you
know how they correlate in the first place. I won’t bore you with
more jargon, because the overall results will not surprise you. It turns
out that the de facto strategy at TotalCare is to give minimal service
to our mainly illiterate and ignorant clientele, oiling the squeaky
wheels who have some medical sophistication, basic English, and a
white skin. This may sound crass, Chief, but that’s how the beans get
counted.”
Bellarian, as she predicted, was not surprised. “That may well be
the case, in our HMO as in others, but it could never be an implicit
policy. If true, those numbers must be skewed by one or two
physicians who have yet to follow the guidelines we publish and
distribute internally.”
Ms. Collins shook her head.
“No, I’m sorry to disillusion you, Chief, but over the past ten
years, any TotalCare doctor who did not fit that profile soon found
employment elsewhere. As for policy: again, that is not my concern.
But my analysis of physician performance goes further. In wars,
battlefield surgeons are forced by circumstance to group the
incoming casualties according to the likelihood of their benefiting
from treatment; those who will probably recover with little or no care
are bypassed, as are those who will probably die whether or not they
receive care—even the best. Now, when I run the data from this
perspective, I find that our doctors perform a somewhat similar—but
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