Sometimes the private murmurs in the audience can be just as informative as the pronouncements from the authorities up on stage. That was my experience last month, when I went to Boston to take in a session of a Harvard School of Public Health conference on health care alliances.
The discussion featured 10 health care industry leaders of varying ideological stripes and one facilitator, the engaging Harvard Law School Prof. Charles R. Nesson, J.D. The issue was health care as a profit-making enterprise, and if Nesson was there to draw the speakers out, it had to be admitted that they didn't need much drawing. Malik Hasan, M.D., chairman, president and CEO of Health Systems International, expanded on his own keynote address earlier in the morning to sing the inevitability of the free market, while longtime single-payer crusader Steffie Woolhandler, M.D., M.P.H., promptly announced her goal of putting Hasan and his ilk out of business. When the topic of the uninsured came up I wasn't sure whether Florence Nightingale's beneficence or Adam Smith's wisdom should guide me, but I knew my thoughts were lofty ones.
"We've always provided some charity care to the uninsured," said a Colorado physician to my left. "But if HMOs like Hasan's keep ratcheting down our pay, we won't be able to afford to."
Suddenly I saw the matter in a more practical light.
In this issue we print selections from that Harvard panel discussion — at least from the moments when everyone wasn't speaking at once — because we feel the topic gibes nicely with our cover article (p. 23) on the differences (and similarities) between for-profit and nonprofit health plans these days. In both we quote highly placed "experts," of course, but we hope you'll find their ideas sufficiently ballasted by testimony from physicians and HMO executives "in the trenches." If not, let us know, and perhaps we'll contact that Colorado doctor for a comment that cuts through the abstractions once again.